Project Sonar (PS), a joint program between Illinois Gastroenterology Group (IGG) and Blue Cross Blue Shield of Illinois (BCBSIL), is a community-based registry and disease management program developed to improve clinical and economic outcomes in inflammatory bowel disease. Patient-reported symptoms and health-related quality-of-life information are delivered via electronic health record data and integrated into cloud-based clinical decision support (CDS) tools to relay real-time patient information to physicians. PS data are further combined with claims information to identify changes in cost of care. This study reports performance of PS in a subset of continuously enrolled patients with Crohn's Disease (CD).Methods:
CD-associated claims were identified using ICD-9555 codes. A total of 175 attributed IGG patients with CD were enrolled in PS between September 1, and November 30, 2014. The baseline period was December 1, 2013 through November 30, 2014, and the study period was December 1, 2014 through November 30, 2015. The comparison group (CG) included BCBSIL patients diagnosed with CD during December 1, 2013 through December 31, 2015. Payments for physician and diagnostic services were compiled by BCBSIL and validated by Health Care Service Corporation. Results were analyzed per member per year for each cohort and metrics reported as percent change (pre-baseline to post-baseline).Results:
Both the PS group and CG were 48.6% male with a mean age of 44 to 45 years at baseline. The relative risk assessment declined 1.1% (2.613–2.584) in the PS population versus a 2.2% increase in the CG (2.601–2.659). Crohn's-related emergency department (ED) visits decreased 100.0% for the PS cohort (0.023–0.000) versus a 75.0% decrease for the CG (0.023–0.006). For the PS population, Crohn's hospital admissions increased 14.3% (0.040–0.046), with a 62.3% increase in Crohn's days (0.109–0.117), whereas admissions in the CG increased 100.0% (0.029–0.057), with a 322.2% increase in Crohn's days (0.051–0.217). For average length of stay, the PS group and CG increased 42.8% (2.7–3.9 d) and 111.1% (1.8–3.8), respectively. Crohn's allowed admission payments increased 50.9% for the PS group ($481–$727), with Crohn's allowed medical payments increasing 38.3% ($7977–$11,034); the CG increases were 248.3% for allowed admission payments ($287–$999) and $47.6% ($7535–$11,124) for allowed medical payments. The relative risk of the PS population declined 3% against the CG. CD costs in the PS group rose 9.3% less than the CG, driven by an 84.7% decrease in hospital admissions and a 68.3% decline in average length of stay. CD allowed admission payments in the PS group were 20.51% of the CG.Conclusions:
During the first year of the program, PS patients demonstrated a reduction in relative risk of CD and experienced fewer Crohn's ED visits and hospital admissions than the CG, effectively “bending the cost curve” for CD. PS represents an innovative model of population health and shows trends towards improvements in the relative risk assessment, and reduction in healthcare resource utilization.