17 Jan Rheumatology: The Next Big Chronic Disease Target
Comparable to cancer in prevalence and costs, rheumatology diseases (autoimmune, musculoskeletal, inflammatory), are the next big chronic disease target. While health plans increasingly target chronic disease care: diabetes, hypertension, cancer and mental health—they often overlook a large group of costly chronic disorders. Rheumatic diseases cause chronic pain, impaired mobility and reduced productivity. Left untreated, they can progress to surgery, disability, even death. They are among the costliest conditions in your plan. A specialist shortage, slow uncoordinated patient journeys, information overload and an underused evidence base have led to high costs and suboptimal outcomes. Emerging technology platforms can detect at-risk members earlier, increase specialist efficiency, turn disparate data into actionable information, and support evidence-based care to improve outcomes and control costs. CrossBridge is a leader in bringing such technology to rheumatology, with a powerful software platform to help your plan tackle the next big target in chronic care.
The burden of chronic rheumatologic disease
ACOs, Medicare Advantage, employer-sponsored and payvider plans are facing the challenge of managing chronic diseases. Today, technology vendors offer turnkey solutions to manage patients with cancer, diabetes, hypertension, obesity, and kidney disease. But often overlooked is the growing population suffering from chronic rheumatologic (inflammatory, , autoimmune) conditions, a category already as large and costly as .
These disorders are prevalent and underdiagnosed, affecting 10-25% or more of your population. They cause significant pain and suffering, impaired mobility and reduced quality of life, progressive disability, even death. employers, they are a major cause of lost productivity.[i] For payers, they are costly, particularly autoimmune diseases.
There are some 100-200 rheumatic diseases and syndromes, including conditions such as rheumatoid arthritis (RA), lupus, ankylosing spondylitis[ii] (AS) and psoriatic arthritis.[iii] Prevalence is growing.[iv] RA is the most prevalent autoimmune diagnosis in the United States, affecting some 1.3 million people (.6%).[v] It is also one of the most expensive (comparable to multiple sclerosis – MS), mostly due to the cost of specialty medications (bDMARDs).
The rheumatology predicament
Rheumatology is the medical specialty that treats disorders of the bones, joints, ligaments, muscles and tendons.[vi] Rheumatologists also treat systemic autoimmune diseases. It is now established that early diagnosis and treatment produce better long-term outcomes and reduce major medical costs like emergency use, hospitalization and .[vii] However, delayed and slow patient journeys are still typical for a variety of reasons.[viii]
Estimated US demand for rheumatologists is already twice supply, even as disease prevalence grows.[ix] Uneven distribution leaves rural areas particularly short on specialists. Therefore, referrals to rheumatologists involve at best long waits for initial visits, if patients can find one at all. As expected, people living with poor social determinants of health (SDOH) have the worst access. Also, many patients have comorbidities (physical and emotional) that require coordination across multiple specialists.
Although early detection is crucial, diagnosis is still too slow
Unlike cancer, heart disease and diabetes, there are no screening programs for arthritis or autoimmune disorders. Early non-specific symptoms (e.g., aches, fatigue, fever) are similar across many other diseases, including dozens of autoimmune conditions. Many patients are not referred from primary care to specialists until specific symptoms emerge, after systemic disease has progressed. There are few sensitive and specific biomarkers. So, differential diagnosis is difficult, especially for rarer diseases like AS.
In today’s dynamic medical and pharmacological research environment, the volume of information is too much for any clinician to absorb. For example, there are some 150 drugs on the market used to treat RA as well as many non-pharmaceutical interventions exercise, physical therapy, weight loss, smoking cessation, diet, nutrition and supplements.
The evidence base is underused
In RA, among the best-characterized autoimmune diseases, fewer than 30% of patient care plans are evidence based. The evidence base is too large for any clinician to understand without digital support. For example, the American College of Rheumatology (ACR) 2010 RA diagnosis[x] and 2021 treatment guidelines[xi] are complex, with decision points based on patients’ responses to treatments. Guidelines for rarer diseases like spondylarthritis are no less complex.[xii]
Care is increasingly costly
All the above factors contribute to higher costs. The biggest drivers are the bDMARDs developed since the 1990s. While they have dramatically improved care for many, most are priced at $10-60,000 PPPY. This is a burden for payers, and through co-pays, patients. More judicious use of these drugs, from initial match to patients to monitoring clinical response and decision-support feedback, offers huge potential savings with better outcomes.
How can you speed care and improve outcomes for patients, make care management easier for clinical teams and lower total cost of care?
The technology response
Vendors now offer technology platforms to bridge gaps between patients, providers and payers. Such solutions are gaining traction in several chronic diseases, particularly metabolic and cardiovascular. Rheumatology is the next target. All stakeholders share certain goals: Better patient outcomes, improved provider efficiency, and lower costs. But only with advanced IT has it been tractable to tackle chronic rheumatic disease. Virtual care through telemedicine and patient engagement through apps rely on this technical foundation. Value-based alternative models can only succeed with digital .[xiii]
Make specialists more efficient and effective
Technology supports care collaboration across primary and specialty teams, re-engineers workflows and allows stressed rheumatologists and staff to engage more patients with more compassion and less burn-out.
Detect at-risk members earlier, speed patient journeys
Population analytics can find hidden members with undetected inflammatory diseases or at high risk of developing one. Integrated clinical dashboards speed the journey from initial referrals to specialists through diagnosis, treatment, ongoing monitoring and measurement.
Turn multiple data sources into actionable information
Aggregating and integrating EHRs, claims data, patient-reported outcomes (PROs), SDOH, professional guidelines and other medical data yields information that providers, payers and patients can use to improve care and reduce costs.
Make evidence-based planning and monitoring easier
Turn complicated diagnostic and treatment algorithms into understandable formats that assist nurses and physicians to prepare for patient visits, make better clinical decisions and monitor chronic patients over the long term.
Control costs through all of the above
Move beyond blunt tactics like limited formularies, step therapy and prior authorizations to value and evidence-based paradigms that maintain/improve outcomes while lowering costs through more judicious use of costly drugs and reduced total cost of care including medical spend.
The CrossBridge rheumatology solution
Our platform incorporates proven methods developed by Geisinger’s Steele Institute for Health Innovation, working closely with the Geisinger rheumatology clinical team. With published, peer-reviewed results,[xiv] Geisinger continues to use the platform to manage care for thousands of patients. CrossBridge acquired the technology and is commercializing it as a key component of our integrated patient care and analytics platform for chronic disease.[xv]
How it works
The CrossBridge platform transforms and integrates data from EHRs, patients, nurses and physicians into user-friendly clinical dashboards. These support Evidence-Based Clinical Pathways and enable long-term monitoring of disease activity, response to drugs, and comorbidities.
- Better outcomes in this complex, chronic population: care access, coordination, coaching.
- More precise, accurate risk scoring (RAF) and documentation of often-missed conditions.
- Enhanced quality measures: HEDIS, STAR, Part D. Identify care gaps and facilitate closure.
- More plan member and family satisfaction: 24/7 support, caregiver and patient engagement, improved MHOS scores.
- Enhanced provider efficiency and satisfaction: more resources, coordinated information flow, automated algorithms, patient engagement.
Easy to work with. Skin in the game.
- CrossBridge analyzes your plan data and provides an opportunity summary.
- Members are stratified into relative risk categories: High, Rising and Low.
- Members transition appropriately between risk levels, towards goal of moving lower.
- Flexible business model based on member risk levels.
- CrossBridge succeeds only if savings are generated.
Why CrossBridge tackled rheumatology first
Bill Conlan started CrossBridge in response to his personal patient journey to an AS diagnosis that exemplified all that was wrong with the system. Nine years of uncoordinated, frustrating encounters led him to believe there must be a better way. His background in health IT meant he was the one to create it. He founded CrossBridge to reimagine the care model for patients with chronic autoimmune conditions. Rheumatology was an overlooked, high-unmet need, high-opportunity target, so that’s where CrossBridge focused first.
What CrossBridge can do for you
Reach out to learn more about bringing better care and lower costs to the treatment of these complex, chronic diseases
- Contact us for more information:
- Ask us for a demo!
- Ask for free data analysis of your plan claims as an opportunity assessment.
- Partner with us to build a pilot project or proof of value.
[v] Op cit endnote ii, CDC