Laying the foundation for greater value in inflammatory bowel disease care

New payment models, New regulatory and reimbursement approaches, Health system readiness
/ Healthcare

Inflammatory Bowel Disease Value Framework Initiative, June 2021

Recent innovations have led to major change in the care of inflammatory bowel disease (IBD). Patients suffering from the chronic and debilitating disorders comprising IBD now have treatment options that can relieve their symptoms and prevent progression of the disease. In addition, new advancements on the horizon may further improve patient quality of life and reduce related financial burdens, such as lost wages due to decreased productivity. However, adoption of innovations in IBD care has been uneven to date. Furthermore, the advancement of value-based and alternative payment models, which have become common in other specialties such as oncology, has also been uneven in IBD. Enabling a more rapid and consistent uptake of innovation and shifting to a value-oriented care paradigm in the IBD space will require bridging various gaps in stakeholder perceptions of value.

In the first half of 2021, Tapestry Networks engaged a diverse group of stakeholders, including payers, self-insured employers, pharmacy benefits managers, gastroenterologists and clinical specialists, patient advocacy organizations, industry representatives, and others to address these issues. The effort culminated in a May 2021 IBD Progress Summit, during which participants explored how a multistakeholder collaboration might be able to accelerate the shift to value-based care in a more consensus-driven fashion than is currently the case.

There were several key takeaways from these conversations:

  • Participants identified three key challenges in IBD care: limited endpoints that fail to account for functional outcomes for patients over long periods of time, a heterogeneous patient population requiring more sophisticated risk stratification, and high variation in care, which could be improved by increased standardization across the specialty and advancing holistic approaches to treatment.

  • In reflecting on these challenges, participants largely agreed that focusing on earlier, preventative intervention for IBD patients is the path to value moving forward. Participants emphasized the importance of early, accurate diagnosis to ensure patients are best positioned for optimal outcomes. Furthermore, most recognized that primary-care physicians, general gastrointestinal practices in the community setting, well-honed IBD subspecialists, and ancillary support staff all have roles to play in enhancing care delivery and ensuring access. Some noted that improved collaboration across these professionals could further improve the quality and value of IBD care. •

  • Both specialty medical homes and digital tools could help advance value-based IBD care and the preventative focus noted above, but both are likely to require multistakeholder cooperation to achieve success and mitigate investment hurdles. IBD medical homes are uniquely tailored to provide holistic, coordinated services to patients suffering from IBD, but they are challenging to scale and expensive to initiate. Digital tools have the potential to achieve high degrees of scale for IBD populations and are presented to payers as ready-made, turnkey solutions. However, these tools require patient engagement and, as point solutions for distinct populations within payers’ broader membership, may require better integration and alignment with other value-based initiatives.

  • Establishing consensus-based guiding principles or frameworks could be a valuable next step, as could establishing multistakeholder continuous-learning platforms to accelerate adoption of critical lessons and incubate new partnerships. Payers, clinicians, and others underscored the benefits of creating a framework or set of consensus-based building blocks to provide a foundation for those interested in piloting new approaches to value in IBD. Such a framework or building blocks would make it possible for stakeholders to leverage existing experience and expertise more efficiently. Additionally, a broad-based learning forum could help stakeholders identify opportunities to contribute to value-based initiatives and sensitize those who have not yet prioritized development of value-based IBD programs to the benefits of doing so.

Meeting participants valued the opportunity to hear diverse viewpoints on the above topics and were optimistic about the prospects for tangible progress and multistakeholder cooperation moving forward. Some especially appreciated the level of consensus on prioritizing patient interests. One payer said at the conclusion of the meeting, “The thing that makes me hopeful is that every person here started with the patient. That was really how we started and ended every conversation, and I really enjoyed that.”