To develop their specialty medical home model, Dr. Regueiro, Dr. Szigethy, Ms. McAnallen, and other key UPMC hospital system and health plan administrators, as well as other IBD specialists, met many times over the course of 2 years to plan what Ms. McAnallen calls their proof of concept.
The program is offered automatically to those covered by the UPMC Health Plan, although anyone is welcome to opt out if they choose. Participants are asked, but not required, to submit to genetic sampling for IBD research purposes, and other data also are gathered with consent at the center. Those not covered by UPMC insurance also are welcome to participate. “The center is payer-agnostic,” Ms. McAnallen said.
Dr. Regueiro and his colleagues will be the primary doctors for all patients who want to be seen at the IBD center for their chronic condition, while episodic illnesses such as colds, flus, and rashes are treated by a newly added advance practice nurse. All patients are now offered behavioral and psychosocial support, depending on the concern, either from Dr. Szigethy, a psychologist, or a social worker who was added to the team for the pilot project.
“Part of what we are defining [with this project] is when a psychiatrist is needed, and what can be done by a less expensive, but well-trained behavioral health, medically trained person like a social worker,” said Dr. Szigethy, who is also a member of the department of psychiatry.
A new patient peer group offers patients the chance to discuss their IBD-related struggles with others who can empathize directly, and a nutritionist and pharmacist both specializing in IBD needs have been added to the payroll. A 24/7 call center also has been established.
“We want patients to be in the habit of calling one place where their entire history is known,” said Ms. McAnallen. “Whether they need primary care or specialty care, we want these patients to go to the specialty medical home.”
It’s a patient-centered, rather than an institution-based model, where the referrals are controlled by the payer, “but the system is value based not volume based,” said Dr. Regueiro.