What is on the Horizon for Rheumatology in 2023? - Episode 5

Alternative Payment Models in Rheumatology

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Dr Nehad Solman reviews the role of clinical pathways and alternative payment models in rheumatology as well as anticipated changes for 2023.

Nehad Soloman, MD: As we continue on in the future, in 2023 we know that Medicare amongst others are asking for alternative payment models. They're asking for us to be more defined. This is an opportunity for us as rheumatologists to pave the path forward as opposed to having somebody else tell us what to do. Some of the challenges, of course, that we face in rheumatology is that we don't have structured pathways that have been defined. For years, it's been, let's try and see what happens. We've had guidance from American College of Rheumatology in terms of guidelines, and some folks will use that to develop pathway programs. I think the challenges when dealing with payers is how do you develop a pathway program that is primarily good for patients, secondarily, a cost savings to society. Because the way it is structured, alternative payment pathways are based on a cost savings. It's based on better outcomes. It's based on precision medicine. If you can eliminate much of the trial and error approach and be more specific and exact with the outcomes of your therapy selection, then you will have success long-term in terms of cost to society, hospitalizations, comorbid conditions, comorbidities, deaths, and all of those things that add further cost to the cost burden to society.

It is my expectation that moving into 2023 and beyond that alternative payment models will include precision medicine-type testing such as the Prism RA test. Possibly methotrexate PG levels. Any type of tool that will help guide our hand in therapy, help inform us and inform our treatment decision-making to provide better outcomes for patients. Rather than just escalating methotrexate dose in the dark, polyglutamate level may help us decide whether that's necessary or not. Whether it's choosing the first biologic and which the Prism RA test, it continues to evolve, may help us make better-informed decisions for our patients. I'm hopeful that incorporation of these scientific tests and specific to the patient tests will drive payment pathways forward.

Transcript Edited for Clarity