Background/Purpose: The RA care pathway initiative at Allegheny Health Network (AHN) was launched in collaboration with Highmark Health with the aim to improve clinical outcomes while optimizing value. Our study aims to compare clinical outcomes, health care utilization and costs between patients in the AHN RA care pathway cohort and patients receiving usual care and thereby identify opportunities for improvement.

Methods: The AHN care pathway initiative was implemented in 3 phases: definition phase, 2020 Q1 (define and align on outcomes that matter, such as classification criteria, outcome measures), data collection and team building phase, 2020 Q2-2021 Q4 (process design and implementation of prospective data capture tools and team-based care), and ultimately measurement phase, 2022 Q1- 2023 Q4 (best practice performance metrics linked to population health and value-based care). At the end of our study in 12/2023, we compared clinical outcomes (percentage of patients in CDAI based remission), health care utilization (ER and inpatient), and per member per month (PMPM) costs of care (total, drug-related and RA-related) of the RA care pathway cohort with usual care among Highmark insured patients.

Results: The RA care pathway cohort included 914 patients at end of the measurement period, of which 372 had continuous Highmark enrollment data. Patient demographics and RA best practice performance metrics in the 1st and 2nd year of measurement period are detailed in table 1. Of these 124 patients had newly diagnosed RA with a median time to remission of 115 days, and 71.3% patients were in remission/low disease activity in the end. A comparison between the care pathway and usual care groups is outlined in table 2. At the end of our study period, the care pathway cohort had significantly higher proportion of patients in remission compared with the usual care group (51.3% vs. 44.1%, OR 1.34, 95% CI 1.05-1.71, p 0.014) with significantly higher rates of remission at 3, 6, 12 and 24 months into the care pathway. Total PMPM costs, biologic costs and adherence were significantly higher in the care pathway group compared to usual care, although RA related costs were marginally higher in usual care at end of study. ER visits were higher in the care pathway cohort in the 1st year and ER/inpatient utilization were numerically higher in usual care in the end. Within the care pathway cohort, patients with moderate-high CDAI had significantly higher infection-related ER visits compared to patients with remission-low CDAI.

Conclusion: Our RA care pathway cohort following guideline-based RA best practices alongside team-based care had significantly higher percentage of patients in remission compared to usual care at end of study. PMPM costs were higher when compared to usual care, primarily due to higher biologic costs and adherence, although RA related costs were marginally lower in the end. Within the care pathway group, infection-related ER visits were higher in patients with moderate-high disease activity. Future efforts to improve RA outcomes will include a focus on the subset of patients with moderate-high disease activity, particularly those with higher ER utilization, emphasizing preventative best practices and addressing adverse social determinants.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-outcomes-and-costs-of-care-for-patients-within-the-rheumatoid-arthritis-care-pathway-cohort-at-a-tertiary-care-integrated-delivery-network-a-comparison-to-usual-care/