The shift from volume to value is no longer a hypothetical construct that people debate while continuing to embrace a fee-for-service mindset. Underscoring this point, the strategic initiative recently announced by the Department of Health and Human Services (HHS) aims to relate a larger portion of payments to quality and value.
HHS plans to tie 85 percent of traditional Medicare payments to quality or value by the end of 2016 and 90 percent by 2018.
The hallmarks of a successful value-based strategy are accurate diagnosis and early intervention. Early identification of disease and initiation of therapy allows providers to manage symptoms and slow disease progression. Thus, if a provider can determine the best course of treatment earlier in the disease process, the patient may be able to avoid or delay the most debilitating aspects of his or her condition. This approach not only lowers the cost of care, but can lead to better long-term outcomes and increased patient satisfaction—key components of value-based care.
Although early diagnosis and intervention are important in treating any condition, there are certain situations where the impact is more apparent than others. Examples of this would be diseases that are historically hard to identify, involve multiple rounds of diagnostic testing and frequently rely on expensive treatment options. Autoimmune disease is one example; these disorders often have debilitating and even disabling effects unless properly managed.
A challenging diagnosis
It is estimated that as many as 50 million Americans are affected by autoimmune disorders that include diseases like multiple sclerosis, rheumatoid arthritis, lupus, ulcerative colitis, and Crohn's disease. To put that in perspective, cancer affects 9 million people and heart disease up to 22 million people.
Many autoimmune disorders are difficult to diagnose. Initial symptoms may be non-specific and other possible diagnoses difficult to exclude. These conditions affect many systems in the human body and often necessitate consultations from different medical disciplines, which can lead to fragmented care.
It is not uncommon for the diagnostic journey to take years and cost thousands of dollars. Diagnosis is a clinical determination that involves detailed physical examination, imaging studies and laboratory testing to construct a differential diagnosis for each patient. The number of patients who present with symptoms is much larger than the diagnosed population. Even those individuals who receive a diagnosis often have had to endure a prolonged process. As such, it is easy to see how the current methods for diagnosing autoimmune disorders run counter to the fundamental tenets of value-based care.
Looking to technology
One way to assist providers in taking a more value-based approach to autoimmune diagnosis is to empower them with tools and technology that expedite disease identification, thereby limiting expensive and invasive testing, as well as ineffective, interim therapies that merely mitigate symptoms until a definitive diagnosis is reached. Exploration of new, innovative diagnostic tools, such as those that are RNA-based, can facilitate this approach by providing both accurate and timely results. Gene expression analysis, which is the process of measuring RNA levels, provides a snapshot of what's happening in a patient's cells. In certain situations, a blood test can provide information about key biomarker determinants, giving the provider the opportunity to make an earlier diagnosis and start treatment sooner. These technologies complement a physician's current diagnostic process and serve to enhance the provider's ability to deliver high-quality patient care. By providing actionable results, these new diagnostic tools allow physicians to further the value equation and take substantial steps toward delivering on the promise of personalized medicine.
To deliver true value-based care, providers also have to pay attention to the patient experience. Determining whether a person has an autoimmune disorder can be a difficult and disconcerting process for the patient. Diagnostic tools can play a pivotal role in elevating patient satisfaction and enhancing the patient experience by increasing the information available to the provider, so he or she can reach a definitive diagnosis more quickly and initiate appropriate treatment sooner to get the patient on a path to better health and quality of life.
An essential tool in the value-based care toolbox
Leveraging emerging technologies, such as novel RNA-based diagnostic tools that provide actionable information, can allow physicians to adhere to the doctrines of value-based care, even for the most challenging diseases. As organizations inexorably turn away from fee-for-service and toward value-driven care, technology that empowers physicians to accurately diagnose and treat complex conditions faster will enable more responsive, proactive and cost-effective care that improves outcomes for providers and enhances quality of life for patients.
About the Author
Through combined experiences in the laboratory and clinic, Dr. Spurlock is committed to translating basic science discoveries into improved diagnostic strategies for patients with autoimmune conditions. As CEO of IQuity, he has day-to-day oversight of all aspects of the company ensuring the vision and mission is realized.
Dr. Spurlock's published work explores the molecular basis for autoimmune disease and further examines therapeutic targets in the management of these diseases leveraging a diverse set of genomic and biochemical approaches including gene expression and next-generation sequencing technologies.
Dr. Spurlock is a Phi Beta Kappa graduate of The University of the South where he received his bachelor's degree in biology, magna cum laude, with departmental honors. He earned his Ph.D. in microbiology and immunology from Vanderbilt University School of Medicine, where he was awarded the Sidney P. Colowick award for outstanding research and continues to serve on the faculty.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.