CareFirst BlueCross BlueShield, Cardinal Health develop clinical pathways program for RA

BALTIMORE — CareFirst BlueCross BlueShield and Cardinal Health Specialty Solutions on Tuesday launched the nation's first clinical pathways program for rheumatoid arthritis, a chronic disease that leads to inflammation of the joints and surrounding tissue and affects nearly 2.1 million Americans each year.

"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," stated Winston Wong, associate VP at 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."

Cardinal Health Specialty Solutions provides clinical, reimbursement and distribution services to help healthcare professionals, payers, and pharmaceutical and biotech companies deliver quality, cost-effective care to patients with complex diseases. One of its flagship service offerings, P4 Pathways, helps payers 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 Norman Gaylis, managing partner of Arthritis and Rheumatic Disease Specialists in Aventura, Fla. The steering committee is chaired by Herbert Baraf and 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 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.

"Innovative programs like this are creating a new paradigm for enabling payers and physicians to work together to improve the quality and costs of care," said Roshan Girglani, VP 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."

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