Gastroenterology Associates of New Jersey needed to optimize care and capacity: Reimbursement gets tighter every year while patient demand grows. The practice aims to improve access for necessary in-person care and procedures while offering patients complementary proven interventions ideally suited for telemedicine.

THE PROBLEM

"Gastroenterology is a complex specialty," said Dr. George N. Pavlou, gastroenterologist and president and CEO of Gastroenterology Associates of New Jersey. "We diagnose and treat dozens of diseases of the digestive tract, liver and pancreas, as well as provide essential screening procedures for early detection of colorectal cancer.

"Like so many specialties, GI is facing a huge backlog of preventive care and deferred screenings as well as treating patients to achieve and maintain remission," he continued. "Our eight advanced practice providers are seeing patients all day; our 42 gastroenterologists are caring for patients all day and after hours."

Meanwhile, the operations of the practice handles a daily flood of patient messages, insurance and prior authorization requests, and coordination of appointments and follow-ups.

"A large percentage of patients come to us with functional gastrointestinal disorders [FGIDs], also known as disorders of the gut-brain interaction [DGBIs]," Pavlou explained. "These are cyclical issues caused by atypical functioning of the digestive tract rather than a structural problem or infection. They cause a host of symptoms that can be debilitating, greatly impacting all aspects of a patient’s life and wellbeing.

"Treating these patients requires a customized management plan and frequent touchpoints to guide patients through dietary and behavioral changes," he said. "The reality is that few GI practices, even a sophisticated high-quality practice like ours, are structured or staffed to provide high-touch dietary and behavioral interventions."

Most, if not all, patients with chronic GI conditions benefit from these conservative yet proven interventions, he added.

"Frequent touchpoints with a registered dietitian or a GI psychologist are easier to deliver via telehealth, much to patients' convenience," Pavlou noted. "The interplay between the brain and the gut is something to be unpacked through dialogue, education and response – to help patients understand and manage the effects of foods, stress, anxiety, depression and sleep on their GI health. This can make a huge difference between flare and remission of any chronic GI condition.

"Patients come to us for answers, and especially for patients dealing with DGBIs and functional overlap for organic conditions, we need to have more to offer them – especially with complicated diets and behavioral health interventions that are almost impossible to figure out without specialized clinicians," he said.

PROPOSAL

"A virtual multidisciplinary GI care partnership is an extension of our practice – ideally suited to deliver the interventions that will improve our patients’ lives and outcomes," Pavlou said. "Hybrid virtual care is also well-suited to support care plan iteration and compliance, to answer patient questions as they arise, and to coordinate care with providers outside of our practice.

"Our goal is to surround our patients with a multidisciplinary care team in pursuit of achieving true control over their symptoms," he continued. "Symptom control can avoid disease escalation, and this model has data supporting a reduction in avoidable surgery and emergency room utilization. This not only provides a significant benefit to the patient but benefits the larger health system and improves the experience for our gastroenterologists as well."

Pavlou said staff know their health system can be difficult to navigate, so they also aim to alleviate the feeling that patients need to quarterback their own care.

"Lastly, we also know an activated, empowered patient is more likely to keep up with preventative screening procedures – creating a virtuous patient referral pipeline into our practice," he said. "Colorectal and esophageal cancer is treatable with early detection."

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MEETING THE CHALLENGE

Dietary interventions are especially well-suited to digital health, where people can have more frequent check-ins with a registered dietitian and share analytics on food and symptom tracking that is very cumbersome to do in an in-person format, Pavlou explained.

"Anyone who's tried to change their diet knows how hard it can be," he said. "And for people with digestive health issues, diets can be incredibly restrictive and difficult to implement and maintain. One common dietary intervention used in gastroenterology is the low FODMAP diet, which eliminates – and then reintroduces – a broad category of foods likely to cause GI symptoms and can be a difficult diet to pursue alone.

"Working with a registered dietitian allows patients to quickly identify triggers and shift gears to different therapies if this particular diet doesn’t work," he noted.

Gastroenterology Associates of New Jersey also sees patients with considerable anxiety associated with their GI conditions – which of course makes symptoms worse.

"Working with psychologists and therapists who are specially trained in GI conditions and gut-brain interventions is critical, but access to these specialists locally is rare – and usually comes with a high out-of-pocket burden for patients," Pavlou said.

"Giving patients the best of virtual and in-person care is supported by two-way information exchange," he continued. "Co-managed patient care is achieved through EHR and health information exchanges, as well as more traditional means of collaboration like provider-to-provider calls where discussion is warranted. This hybrid model has a purpose-built commitment to data sharing and integration."

RESULTS

The endpoints the practice is measuring are aspects already proven: access, patient outcomes and enhanced care, Pavlou explained.

"Beyond scaling access to care, hybrid virtual care will bring wider value to our medical group to optimize practice capacity and support operational excellence by focusing on what happens between visits," he said. "In gastroenterology, where access and cost have become the focus of health plans, hybrid collaboration enables multidisciplinary care, standardized outcome measurement and an exemplary patient experience.

"We will be measuring all of these metrics and believe the impact on our patients’ lives will differentiate our practice," he added.

ADVICE FOR OTHERS

"In this time of ever-growing patient demand and overburdened clinical practices, I advocate that assessing and negotiating the right partnerships with digitally enabled virtual care clinics needs to be a core competency for the next generation of medical group leaders," Pavlou advised. "Geography, subspecialty access, payment models and clinician culture are all factors they must take into account when determining the right model for hybrid partnerships.

"With the right execution, this extension of the care team can optimize practice capacity for necessary in-person care, improve and measure outcomes, and empower their clinicians with better options for their patients," he concluded.

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