Key to controlling Crohn’s cost is avoiding complications, engaging patients in their care plans.
Specialists Can Build Their Own Medical Homes, 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.