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Article Title

Geisinger’s Use of Clinical CarePaths: Impact of a Psoriasis CarePath on Process, Clinical, and Economic Outcomes

Publication Date

8-10-2017

Keywords

quality of care, managed care (features), ambulatory/outpatient care, clinical practice patterns/guidelines, engagement of stakeholders, clinical decision-making, health care costs/resource use, dissemination and implementation of innovations, quality improvement, pharmaceuticals

Abstract

Background: CarePaths are evidence-based integrative care processes that seek to treat patients with complex diseases in a standardized manner. Herein we describe the development and implementation of the CarePath for psoriasis and present preliminary economic and clinical outcomes of this streamlined process.

Methods: The CarePath for psoriasis was developed through a five-step process involving population identification, care algorithm development (synchronized to coverage determinations), IT development, patient-family engagement, and outcome monitoring utilizing input from our integrative delivery network of patients, providers and payers. Over the course of 12 months, the multidisciplinary team developed standardized data elements within the electronic health record (Epic) and a psoriasis-specific performance dashboard to ensure consistent population targeting, outcome monitoring and provider compliance tracking. Monitoring within the build allows for evaluations of the adoption of the CarePath including: body surface area tracking and completion, inclusion of psoriasis on the patient’s problem list, utilization of nonpharmacological options (eg, light therapy), and drug therapies used. A simple cost-avoidance model of selecting light therapy over alternative biologic therapy was employed to calculate savings.

Results: Adoption of the psoriasis CarePath has steadily increased since its launch in July 2015. Inclusion of psoriasis in the problem list of affected patients steadily increased in the 12 months post-CarePath launch. Tracking of body surface area measurements increased from 41.7% to 76.3% over the same time period. A total of 72 patients initiated light therapy since CarePath implementation, 61 of whom were biologic candidates and 11 who switched from biologics. With an estimated 6-year single patient cost of $2,200 for one ultraviolet light or $294,000 for formulary biologic alternatives, the psoriasis CarePath is estimated to save the health system $21,009,600 ($3,501,600/year).

Conclusion: Through the psoriasis CarePath, we have been able to standardize the care of patients across Geisinger Health System by providing patient-focused, evidence-based care at substantial cost savings. Lessons gleaned through the early success of the psoriasis CarePath are being applied to CarePath construction for rheumatoid arthritis, heart failure, pulmonary hypertension and other diseases.

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