Exploring the Cost Benefits of Cloud-Enabled Testing for RA Diagnosis

The use of rapid, cloud-enabled, onsite testing for rheumatoid arthritis (RA) has great potential to generate value to payers and lower the number of office visits for the average patient, according to recent research published online in the Journal of Medical Economics.

To better understand how onsite testing can improve patient care while positively impacting the cost of care for payers, lead study author Katalin Bognar, PhD, research economist at Precision Health Economics, sat down with First Report Managed Care.

Please tell us about yourself and your research interests.

I am a Research Economist at Precision Health Economics, with interests in health economics, economic modeling, and econometric analyses. In my research I use a wide range of methodologies and data sources to better understand the traditional and broader social value of various treatment options, diagnostic tools, and devices. I have experience in conducting real-world, administrative claims-based analyses, and designing surveys and developing health economic models. I have worked on various autoimmune, cardiovascular, metabolic, musculoskeletal, and oncologic diseases.  My research has been published in a variety of peer-reviewed journals, including the Journal of Economic Theory, Journal of Health Economics, Journal of Medical Economics, American Journal of Emergency Medicine, and American Journal of Cardiology.

Please highlight the developments of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). What is the importance of this RA testing for payers?

To successfully manage patients with rheumatic diseases, providers rely heavily on laboratory tests. For example, during disease monitoring visits, rheumatologists frequently order a complete metabolic profile (CMP), complete blood count (CBC) with automated differential, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). In some cases, thyroid stimulating hormone (TSH) and vitamin D levels are assessed. If the patients are prescribed a disease-modifying antirheumatic drug (DMARD), then currently accepted standards require assessment for hepatitis and tuberculosis are added to the test order. For patients who are initially assessed for RA, the test menu would be expanded to include rheumatoid factor (RF), cyclic-citrullinated peptide (CCP) antibodies, and possibly quantitative immunoglobulins.

These tests are typically evaluated in centralized laboratories to allow for necessary rigorous quality control; however, this approach introduces a discontinuity in care by delaying treatment decisions until the lab results are available and the patient returns for a follow-up visit. Further, this discontinuity sometimes results in a delay in interpreting results, as the tests are not all ready at the same time.

The concept of rapid, cloud-enabled, onsite laboratory testing is that of a mobile laboratory—smaller than a standard refrigerator—that can be deployed in the physician’s office along with a phlebotomist and a trained operator. With the available instruments, combined with a cloud-based quality management system (QMS), a comprehensive battery of blood tests (>50)—including the ones mentioned above—can be run in the physician's office, with results in approximately 15 minutes.  The instrument performs the assays, and the digital results data are transmitted via the cloud to a central facility where a certified Clinical Laboratory Scientist performs quality control, verifies and then releases results to the physician, all during the patient’s office visit.

In short, the system allows providers to care for patients more efficiently, manage patients with fewer office visits, and increase the likelihood of early treatment initiation, which is especially crucial in RA. These are all advantages that clearly generate value for payers.

Please highlight the findings of your study. What were major advances seen with onsite testing?

We built an economic model to monetize the value of implementing a rapid, cloud-enabled, onsite laboratory at a rheumatology office for patients with RA. We used findings of field experience and observational studies reporting the effect of the system on the number of office visits and the likelihood of completing testing orders. We fed these inputs into the model and our results suggest that the value of implementing an onsite system is about $5000 per evaluated patient-year. Most of that value comes from improved health outcomes associated with prompt initiation of cost-effective therapies, but value to payers from fewer office visits and repeated lab tests also contribute to actual savings in health care costs. Lack of comprehensive studies on patient outcomes, our model did not capture benefits for diseases other than RA but there could be additional savings to payers associated with early diagnosis of other high-dollar chronic condition.

How does onsite testing impact the cost of care?

As mentioned above, onsite testing enables providers to better manage their patients. The number of visits per patients may drop, which saves valuable time for physicians and patients. We explicitly included time saved on follow-up visits in our modeling framework, but it is likely that physicians further save time on chart re-review.

Can you discuss the value this testing has to payers?

Our model suggests that there may be value of approximately $5000 per evaluated patient-year for payers. The majority of this is due to improved health outcomes as a consequence of early treatment initiation, which is reported to be a cost-effective way of managing patients with RA. Although not quantified in our model, streamlining care is especially important in the field of rheumatology, where a shortage of providers leads to barriers to access. For instance, if providers are able to manage patients more efficiently with fewer visits, this may open up capacity and potentially reduce waiting time for new patients.

Is there anything else you would like to add?

Thank you for the opportunity to share the results of this interesting work.

Reference:

Bognar K, Shafrin J, Brauer M, et al. The potential value of rapid, cloud-enabled onsite testing for the diagnosis of rheumatoid arthritis in the United States [published online August 16, 2018]. J Med Economics. 2018;21(11). https://doi.org/10.1080/13696998.2018.1502191