CareFirst BlueCross Blue Shield and Cardinal Health Specialty Solutions have announced a joint effort to create a clinical pathways program for rheumatoid arthritis (RA), a chronic inflammatory disease that affects more than 2.1 million people annually.
Working in CareFirst's coverage area of Northern Virginia, Maryland and Washington, D.C., the two companies have brought together nearly 70 rheumatology practices and more than 100 rheumatologists who will use Cardinal's P4 Pathways tool that helps payers and providers work together to create evidence-based clinical protocols for the treatment of complex diseases.
Under the program, CareFirst and Cardinal will work with the individual physicians to develop and implement a "treat-to-target" approach to RA care whereby different treatment options are tested until a patient's symptoms are in remission.
Participating physicians will leverage information derived from each patient's Clinical Disease Activity Index (CDAI) score – which measures the degree to which patient mobility is affected by RA – to standardize the way rheumatologists treat RA patients. When CDAI scores indicate that patients have not favorably responded to a therapy after three months, CareFirst's new RA pathways program provides guidance to help participating rheumatologists determine the next, most appropriate treatment option.
"Innovative programs like this are creating a new paradigm for enabling payors and physicians to work together to improve the quality and costs of care," said Roshan Girglani, vice president and general manager of rheumatology for Cardinal Health Specialty Solutions, in a press release. "Our ultimate goal is to leverage collaborative efforts like this to ensure patients continue to have access to quality, personalized care in the community practice setting – where care is proven to be most convenient and cost-effective."
Through the P4 Pathways Program for Rheumatoid Arthritis, physicians will have the opporuntity to pilot a new electronic tool that helps physicians measure patient CDAI scores by monitoring disease progression and the effectiveness of therapy. The tool will employ touch-screen technology to increase accessibility for patients with limited dexterity, and helps physicians determine when medication regimens need to be modified.
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In addition, physicians will work with Cardinal Health Specialty Solutions and CareFirst to develop new 'pay for quality' programs that reward doctors for taking proven steps to improve the quality and cost efficiency of RA care. They will also collaborate to develop new ways to compensate physicians for delivering cognitive care to patients; and to ensure participating physicians receive higher rates of reimbursement in recognition of pathways compliance.
Cardinal Health Specialty Solutions will also provide additional proprietary technology, tools, educational programs and training to help participating physicians within the CareFirst network implement and monitor use of the clinical pathways. These tools will also capture clinical results and track cost savings of the program, without additional administrative work for participating physicians.
"Working with Cardinal Health on a similar program focused on oncology, we have learned that physicians embrace the opportunity to take an active, leading role in working to improve the quality and reduce the costs of patient care," said Winston Wong, associate vice president, CareFirst Pharmacy Management. "We're excited to apply P4 Pathways' physician-centric approach to pioneer innovative new ways to improve the way we care for patients with rheumatoid arthritis."