The Task Force was developed by a AGA commissioned task force who reviewed current literature and identify examples of integrated IBD care within both academic and community settings
The American Gastroenterological Association has published a White Paper that assessed the impact of mental and psychosocial factors on the care of patients with Inflammatory Bowel Disease (IBD), to provide “gastroenterologists with information that would help them incorporate psychosocial aspects of IBD care into their practices.
The paper, ‘White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease’, published in the journal Clinical Gastroenterology and Hepatology, was developed by a AGA commissioned task force who reviewed current literature and identify examples of integrated IBD care within both academic and community settings. The subsequent consensus statement summarises these findings and highlighted several overarching factors will enhance IBD care including:
- Mental health factors with a focus on essential screening and intervention steps
- Psychosocial factors that warrant identification and intervention. One particularly neglected area in need of better focus is racial/ethnic factors.
- Health system factors including barriers to access providers during a disease crisis, financial constraints for both patients and providers, and a lack of readily available resources to deal with positive mental health screens.
The paper states that IDB patients have estimated annual direct health care costs of US$1.7 billion, (about $12,000–$20,000 per patient), with costs of concurrent depression among patients with chronic disease conditions estimated to be US$210 billion annually across the 15.5 million adults with major depression in the US (although not quantified directly in IBD patients).
Therefore, the goal of this paper was to provide background knowledge and practical tools for gastroenterology practices to understand the psychosocial factors linked to disease course, quality of life, related disability.
However, the paper acknowledges that the integration of behavioural health specialists into IBD practices is relatively new and still rare. It is known that the most prevalent mental health conditions in patients with chronic illnesses are depression, anxiety disorders, chronic pain, fatigue and additional psychological factors, and the most effective is a collaborative care model.
However, there are several health system barriers that need to be addressed for a successful integration of behavioural/psychosocial care into IBD clinical settings, the White Paper states, including a lack of resources, financial constraints of patients and providers, and a lack of appropriate reimbursement models.
After examining multiple psychosocial, racial, ethnic, financial, and gender identity issues affecting the care of IBD patients, the Task Force identified examples from both community practices and practices (both academic and non-academic) associated with large health systems that have successfully implemented some parts of integrated IBD care.
According to the White Paper, the single largest barrier to implementing psychosocial care into routine IBD practice has been a lack of payment support and highlights a type of alternative payment mode used by a large New Jersey–based payer based on a total payment for an Episode of Care (EOC) of IBD including psychosocial care.
EOC model is based on all care delivered to a particular patient that is related to IBD across the full continuum of care by ensuring:
- Payment is linked directly to a combination of quality outcomes, patient experience and cost.
- Payments are based on retrospective adjudication, where providers are paid fee-for-service and episodes that are completed during the measurement period are retrospectively evaluated against pre–agreed on metrics.
Such EOC programmes should have the following characteristics:
- Incorporate no/low risk to providers to allow for collaboration
- Have upside potential for patient and provider
- Be constructed to allow administration by both providers and payers
- Be established for a long enough period to allow for effective care transformation
- Avoid further aggravation of historic strained relations between payers and providers
- Create a platform to migrate to accountability for care across the full continuum
“Clearly, reforms in health care delivery and reimbursement are generating innovative care models as risk begins to be shared among patients, providers, purchasers of health care, and health systems in ways not previously seen,” the paper concludes. “Mounting evidence about social and psychological determinants of health, health disparities, and cultural barriers to health points us in directions of a “Whole-Person” care paradigm…This white paper has outlined reasons for an integrative care model, specific tools to help construct the model, and working examples of patient-focused care. Innovative practices can use these tools and concepts to meet the challenges of emerging alternative payment models as we evolve our care delivery processes toward higher health value for our patients.”
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