Reprinted with AIS Health permission from the June 2024 issue of Radar on Specialty Pharmacy.
Data from two clinical studies found that people with inflammatory bowel disease — ulcerative colitis and Crohn’s disease — who were enrolled in one company’s IBD-focused digital care coordination program experienced decreases in both emergency department (ED) visits and hospitalizations compared with control groups. The data, says the company’s CEO, show the benefits of partnerships among stakeholders to manage chronic gastrointestinal (GI) care.
Established in 2018, SonarMD, Inc. enters into risk-bearing value-based care arrangements with health plans and gastroenterology practices. It currently has five such arrangements with large plans and partners with hundreds of U.S. gastroenterologists.
The company offers a digital platform that can identify symptoms of clinical worsening in people with complex, chronic GI diseases. It also provides holistic health programs via partnerships with providers that offer services to improve patients’ diets, mental health and sleep.
Patients take a text-based health assessment monthly, and the SonarMD platform “quickly evaluates their symptoms and calculates their degree of risk of deterioration,” explains Beth Houck, CEO of the company. “This proactive check-in also allows for them to reach out with goals, concerns and questions,” and this “further reduces the barrier to care and ensures that patients maintain their status.”
“GI physicians do not have the proper incentives in place to manage these complex diseases and therefore need a solution that enables them to provide supportive services to their patients,” she contends. “Our technology and longitudinal dataset allow us to easily monitor, risk adjust and cohort thousands of patients each month with a personalized approach with zero impact on provider resources and staff.”
Via standardized clinical protocols, SonarMD is able to “provide extensive triage on behalf of our provider partners who ultimately determine and execute on the care plan,” says Houck. “Fostering our partnered providers’ clinical autonomy is central to our mission.”
A study published in Gastroenterology in 2018 revealed that the annual health care costs for GI disease in the U.S. are $136 billion — more than that of heart disease ($113 billion), trauma ($103 billion) or mental health ($99 billion). GI diseases result in 3 million hospital admissions per year, costing $31 billion.
In addition, says Houck, “we determined that an unmanaged chronic GI patient can significantly impact the overall spending of other procedures and conditions.”
Lawrence Kosinski, M.D., a gastroenterologist, founded SonarMD after realizing that his IBD patients “were showing up in high-cost settings without prior warning” and needed more points of contact between doctor visits, she says. Kosinski “recognized that while specialists have the expertise to effectively manage chronic GI conditions, they can only practice reactive medicine. He saw the opportunity for patient engagement and analytical tools to provide high-touch, proactive care.”
Improvements Seen in ED Visits, Hospitalizations, Surgery
During Digestive Disease Week, which took place May 18 through 21 in Washington, D.C., SonarMD presented posters with the findings from two clinical trials of people with IBD.
The first study included 495 IBD patients who were continuously enrolled from Jan. 1, 2021, through Dec. 31, 2022, and had access to the SonarMD platform. They were patients at three New Jersey medical practices — Allied Digestive Health, Gastroenterology Associates of New Jersey and Digestive Healthcare Center — and were members of the same statewide health plan. They were matched with 2,695 controls with IBD who were patients of other practices that worked with the health plan but did not offer the SonarMD platform.
Over the first calendar year, the SonarMD group had 18% less IBD-related ED visits, a 20% lower rate of inpatient admissions related to IBD and a 40% lower rate of IBD-related abdominal surgery than the control group. In the second year, those differences were even more pronounced: The SonarMD group had 46% less ED visits, 78% less inpatient admissions and a 55% lower rate of abdominal surgery. Those first two rates in 2022 were statistically significant.
Houck noted that SonarMD managed “several thousand patients” during the study’s time frame but wanted to evaluate people who were continuously enrolled in the health plan. “As patient/plan turnover is often significant, we were pleasantly surprised that almost 500 patients had continuous enrollment and engagement with our platform.”
Asked what the improvement in the second year could be attributed to, Houck cites several factors, including an increase in patients’ and providers’ familiarity with the SonarMD platform, “leading to better adherence to its recommendations and protocols. This increased comfort and trust likely resulted in more consistent and effective use of our monitoring tools.”
In addition, the company was able to make improvements to the program based on feedback from the first year, as well as from SonarMD’s analysis of that data. For example, the firm’s data science team discovered a “very strong correlation between specific symptom responses and hospitalization within the following 30 days,” so it was able to update the program’s protocols and “drive the patients to their provider instead of ending up in the hospital as an acute episode.”
Data Analysis Prompted Updates
Patients and providers also may have undergone behavioral changes after using the program, “such as better disease management practices and more proactive care,” she added.
“We are the first company in the chronic GI space to have such an extensive dataset with clinically validated outcomes as compared with a risk-adjusted control group,” declares Houck. “This study is further validation of our model’s effectiveness and shows how to properly engage specialists in value-based arrangements.”
The second study had a SonarMD cohort of 1,008 people with IBD who were continuously enrolled from Jan. 1, 2022, through Dec. 31, 2022; were patients of Minnesota Gastroenterology who had at least one visit within the previous 18 months; and were members of a single major health plan. The control group consisted of 1,657 members of that plan who were not patients at Minnesota Gastroenterology.
Over the year of the study, the SonarMD/Minnesota Gastroenterology group had 15% less IBD-related ED visits, a 14% lower rate of inpatient admissions related to IBD and an 11.5% lower rate of IBD-related abdominal surgery than the control group.
According to Houck, Minnesota Gastroenterology “has an extremely well-managed IBD program in place, so this study demonstrates that even in best-in-class practices, this proactive engagement can have an impact.” She tells AIS Health, a division of MMIT, that SonarMD consistently has member engagement rates higher than 80%, and this “highly engaged population had immediate reductions in their utilization, improving their outcomes and overall quality of life.”
Overall, she maintains, health plans can reap “significant benefits” by entering into a “payer-provider-industry partnership to manage chronic GI care. SonarMD has extensive years of experience aggregating risk-based contracts to help improve outcomes and properly align incentives. It is a win-win for the payer, provider and, most importantly, the patient.”
Houck notes that contracting with payers takes time, “which can prove difficult for a company at our stage.” It also takes time to get claims data supporting the efficacy of its program. By sharing the peer-reviewed results, SonarMD hopes to speed up the validation process that plans require.
“We don’t disintermediate the patient’s GI provider, this program aligns incentives, and — at the same time — it adds additional resources to better manage their most complex patients,” she says. “At the end of the day, we all want the best care for patients, and now we have even more results that prove we know how to do so successfully.”
By Angela Maas
