CareFirst BlueCross BlueShield, Cardinal Health Specialty Solutions Launch First Clinical Pathways Program for Rheumatoid Arthritis

Companies Apply Physician-centric Methodology to Pioneer New 'Treat-to-Target' Approach for Improving Quality, Costs of RA Care

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Cardinal Health

Nov 01, 2011, 08:30 ET

BALTIMORE and DUBLIN, Ohio, Nov. 1, 2011 /PRNewswire/ -- CareFirst BlueCross BlueShield (CareFirst) and Cardinal Health Specialty Solutions today launched the nation's first clinical pathways program for Rheumatoid Arthritis (RA), a chronic disease that leads to inflammation of the joints and surrounding tissue and affects nearly 2.1 million Americans each year.

Cardinal Health Specialty Solutions provides clinical, reimbursement and distribution services to help healthcare professionals, payors and pharmaceutical and biotech companies deliver quality, cost-effective care to patients with complex diseases. One of its flagship service offerings, P4 Pathways, helps payors and physicians to work together to develop evidence-based clinical protocols, or pathways, to improve the way care is delivered to patients with complex diseases.

CareFirst is one of the largest managed care health plans in the Mid-Atlantic, serving nearly 3.4 million members in Maryland, the District of Columbia and portions of Northern Virginia.

Together, CareFirst and Cardinal Health Specialty Solutions have engaged nearly 70 rheumatology practices and more than 100 rheumatologists to participate in a new P4 Pathways program with the goal of improving the quality of care and reducing costs of caring for Rheumatoid Arthritis patients. The program is focused on helping physicians implement a 'treat-to-target' approach to RA care, where they test different treatment options until a patient's symptoms are in remission.

A steering committee comprised of rheumatologists throughout the CareFirst network worked together to develop the clinical pathways and will meet regularly to update the pathways as new clinical evidence is available. Recognizing the importance of physician involvement in the development of pathways, the steering committee is moderated by Dr. Norman B. Gaylis, FACP, FACR, managing partner of Arthritis and Rheumatic Disease Specialists in Aventura, Fla. The steering committee is chaired by Dr. Herbert S. B. Baraf, FACP, FACR and Dr. Alan Matsumoto, who are managing director and senior partner of Arthritis and Rheumatism Associates in Wheaton, Md., respectively.

Participating physicians will leverage information derived from each patient's Clinical Disease Activity Index (CDAI) score – which measures the degree to which patient mobility is impacted by RA – to standardize the way rheumatologists treat RA patients. When CDAI scores indicate that patients have not favorably responded to a therapy after three months, CareFirst's new RA pathways program provides guidance to help participating rheumatologists determine the next, most appropriate treatment option.

"Working with Cardinal Health on a similar program focused on oncology, we have learned that physicians embrace the opportunity to take an active, leading role in working to improve the quality and reduce the costs of patient care," said Winston Wong, Pharm. D., associate vice president, CareFirst Pharmacy Management. "We're excited to apply P4 Pathways' physician-centric approach to pioneer innovative new ways to improve the way we care for patients with Rheumatoid Arthritis."

Through this new P4 Pathways Program for Rheumatoid Arthritis:

Participating physicians within the CareFirst network will have the opportunity to pilot a new, easy-to-use electronic tool that helps physicians measure patient CDAI scores by monitoring disease progression and the effectiveness of therapy. This first-of-its- kind tool leverages touch-screen technology to increase accessibility for patients with limited dexterity, and helps physicians determine when medication regimens need to be modified.

Physicians will work with Cardinal Health Specialty Solutions and CareFirst to develop new 'pay for quality' programs that reward doctors for taking proven steps to improve the quality and cost efficiency of RA care. They will also collaborate to develop new ways to compensate physicians for delivering cognitive care to patients; and to ensure participating physicians receive higher rates of reimbursement in recognition of pathways compliance.

Cardinal Health Specialty Solutions will also provide additional proprietary technology, tools, educational programs and training to help participating physicians within the CareFirst network implement and monitor use of the clinical pathways. These tools will also capture clinical results and track cost savings of the program – without additional administrative work for participating physicians.

"Innovative programs like this are creating a new paradigm for enabling payors and physicians to work together to improve the quality and costs of care," said Roshan Girglani, vice president and general manager of Rheumatology for Cardinal Health Specialty Solutions. "Our ultimate goal is to leverage collaborative efforts like this to ensure patients continue to have access to quality, personalized care in the community practice setting – where care is proven to be most convenient and cost-effective."

About CareFirst

In its 74th year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to more than 3.4 million individuals and groups in Maryland, the District of Columbia and portions of Northern Virginia. Through its CareFirst Commitment initiative and other public mission activities, CareFirst supports efforts to increase the accessibility, affordability, safety and quality of health care throughout its market areas.

About Cardinal Health

Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a $103 billion health care services company that improves the cost-effectiveness of health care. As the business behind health care, Cardinal Health helps pharmacies, hospitals, ambulatory surgery centers and physician offices focus on patient care while reducing costs, enhancing efficiency and improving quality. Cardinal Health is an essential link in the health care supply chain, providing pharmaceuticals and medical products to more than 60,000 locations each day. The company is also a leading manufacturer of medical and surgical products, including gloves, surgical apparel and fluid management products. In addition, the company supports the growing diagnostic industry by supplying medical products to clinical laboratories and operating the nation's largest network of radiopharmacies that dispense products to aid in the early diagnosis and treatment of disease. Ranked #19 on the Fortune 500, Cardinal Health employs more than 30,000 people worldwide. More information about the company may be found at cardinalhealth.com and @CardinalHealth on Twitter.