Inflammatory Bowel Disease Shared Value Initiative

There may be potential to accelerate uptake of value-based care for subspecialty conditions that experience high variability in cost and outcomes, sometimes described as “high-beta” conditions.[i] Inflammatory bowel disease (IBD), an umbrella term for two autoimmune diseases—ulcerative colitis and Crohn’s disease—impacts an estimated 3.1 million (or 1.3%) of Americans and is a high-beta condition that some stakeholders believe would benefit from value-based approaches, especially at a time of change in the treatment paradigm for IBD.[ii]

Tapestry is collaborating with clinicians, payers, industry leaders, patient advocacy organizations, and others on an effort to explore how consensus-based value frameworks and enhanced learning platforms can accelerate value-based care in this sub-specialty through a series of multistakeholder discussions. 

As part of this effort, a group of coauthors from these discussions published a collaborative payer-provider framework in Clinical Gastroenterology and Hepatology that established a shared vision of the principles necessary to enable value-based care and related incentives in IBD (e.g., new payment models or changes to utilization management practices like prior authorization).

Following the framework’s publication, Tapestry engaged relevant stakeholders to explore how these principles could be applied to prior authorization processes, which many identified as a key issue for the subspecialty. Participants discussed research initiatives and purchaser pilots to generate evidence on the potentially measurable benefits for prior authorization modification and the Initiative will continue to explore potential avenues for which such evidence could be published for the benefit of all.

[i] Lawrence R. Kosinski, “Letter to the Physician-Focused Payment Model Technical Advisory Committee,” Department of Health and Human Services, December 21, 2016, iv.

[ii] James M. Dahlhamer et al., “Prevalence of Inflammatory Bowel Disease Among Adults Aged ≥18 Years — United States, 2015,” Morbidity and Mortality Weekly Report 65, no. 42 (October 2016), 1166–1169.