Two years ago, Lawrence Kosinski, M.D., would tell people there’s no place like a specialty intensive medical home. Now he has the data to back it up.
Kosinski is managing partner of Illinois Gastroenterology Group, the state’s largest such practice, which has reduced spending for its patients with Crohn’s disease by almost 10 percent in 10 months.
“We’ve kept the patients healthier and kept them out of the hospital,” Kosinski says. "We're showing strong positive results."
With support from Health Care Service Corp.-affiliate Blue Cross and Blue Shield of Illinois, Kosinski and IGG operate a specialty medical home whose foundation is technology-assisted patient engagement. The model has reduced hospital costs for patients with Crohn’s disease by 57 percent and emergency department costs by 53 percent.
Kosinski was serving as chairman of the American Gastroenterological Association’s practice management and economics committee when he saw how colonoscopies accounted for 54 percent of a typical gastroenterology practice’s income. He became concerned that his specialty relied too heavily on one procedure.
It was critical that gastroenterologists find additional ways to apply their specialty skills, Kosinski says. A study of two years’ worth of BCBSIL claims data on 21,000 patients suggested Crohn’s treatment could be where they might make the biggest difference.
The insurer was spending $240 million on Crohn’s treatment or $11,000 per patient, with half of it going for inpatient stays and often for "devastating complications" such as infections, bleeding, bowel obstructions or fistulas. About 10 percent of the costs were spent on pharmaceuticals and only 3.8 percent was going to gastroenterologists.
What Kosinski found most disturbing, however, was that fewer than 30 percent of patients who required hospitalization had seen a gastroenterologist in the 30 days before admission.
“To control costs, we must control complications,” Kosinski says. “The main driver of cost-containment is patient engagement.”
After an initial visit that includes establishment of treatment goals and formal risk assessment, patients are “pinged” on their mobile phones using a system developed by Kosinski called SonarMD that tracks each patient's condition with a monthly five-question survey using a secure cloud-based web interface. The goal is to detect problems sooner and prevent serious complications.
Harold Miller, president and CEO of the Pittsburgh-based Center for Healthcare Quality and Payment Reform, has been a big supporter of the model Kosinski developed. “It shows how, if you let a physician find ways to save money, you don’t have to cut payments,” Miller says. He added that Kosinski’s model knocks down myths about how specialty care automatically assumes more expensive care, that specialists need incentives to improve care and reduce costs, and that physicians must wait and take direction from the government or insurance companies on health care delivery and payment reform.
"He's an example of how we need more bottom-up resources," Miller says. "He developed an IT solution to support care changes he was making instead of trying to make an existing system work."