title: The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study.
abstract: OBJECTIVE
  Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring.
  
  
  METHODS
  IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups.
  
  
  RESULTS
  In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (-10%, P=0.012), and numerically fewer surgeries (-25%, P=0.49), hospitalizations (-28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (-25 to -86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% ($771) lower than expected (P=0.24).
  
  
  CONCLUSIONS
  These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.
authors.affiliation: aCenter for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles bGehr Family Center for Implementation Science, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine cLeonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles dAnthem Blue Cross, Woodland Hills, California eAbbVie, North Chicago, Illinois, USA fDepartment of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Welmoed K
authors.initials: WK
authors.lastname: van Deen
authors.forename: Arlen
authors.initials: A
authors.lastname: Spiro
authors.forename: A
authors.initials: A
authors.lastname: Burak Ozbay
authors.forename: Martha
authors.initials: M
authors.lastname: Skup
authors.forename: Adriana
authors.initials: A
authors.lastname: Centeno
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Duran
authors.forename: Precious N
authors.initials: PN
authors.lastname: Lacey
authors.forename: Darius
authors.initials: D
authors.lastname: Jatulis
authors.forename: Eric
authors.initials: E
authors.lastname: Esrailian
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Hommes
mesh_terms: D000046:Academic Medical Centers; D000067575:Administrative Claims, Healthcare; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D004334:Drug Administration Schedule; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D015141:Los Angeles; D010865:Pilot Projects; D017064:Process Assessment, Health Care / Q000191:economics / Q000639:trends; D015397:Program Evaluation; D013997:Time Factors; D016896:Treatment Outcome; D000070376:Value-Based Health Insurance / Q000191:economics; D062505:Value-Based Purchasing / Q000191:economics / Q000639:trends
chemical_list: D000305:Adrenal Cortex Hormones