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A virtual, multidisciplinary care program for chronic gastrointestinal (GI) disorders significantly improved patient outcomes while reducing healthcare utilization and costs, according to a recent study.

The researchers studied patients with a new GI diagnosis — predominantly disorders of gut-brain interaction (DGBIs) — who engaged in a multidisciplinary telehealth-based program that included gastroenterologists, dietitians, psychologists, and health coaches. The researchers also compared healthcare utilization and costs incurred by these patients with those incurred in a propensity score-matched control group.

Of the participants, most engaged with the model and experienced marked improvements in symptom severity, quality of life, and satisfaction. They also experienced fewer GI-related emergency department (ED) visits and underwent fewer imaging studies than control individuals. Overall, the care model was associated with substantial cost savings.

“Integrated, team-based care that includes dietary and behavioral health is helpful for managing GI patients with IBS [irritable bowel syndrome] and [patients who have] signs and symptoms consistent with IBS,” corresponding author Sanskriti Varma, MD, of the Division of Gastroenterology at Massachusetts General Hospital and Harvard Medical School in Boston, told Medscape Medical News.

The study was published online in The American Journal of Gastroenterology.

A ‘Gold Standard’ Rarely Implemented

GI conditions, which are “highly prevalent,” not only cause “significant suffering” but also account for “substantial healthcare utilization and expenditure,” the authors wrote.

“We were motivated [to conduct the study] by the significant burden and high costs of chronic GI conditions like DGBI,” Varma said. She noted that traditional care is often “fragmented,” with patients facing long specialist wait times — an average of 48 days — leading to high levels of patient dissatisfaction.

“While evidence suggests multidisciplinary care is the ‘gold standard,’ it is rarely implemented due to limited access to gastroenterologists, GI-specialized dietitians, and GI-specialized psychologists,” Varma continued. “This study aimed to evaluate if a virtual multidisciplinary model could improve access, clinical outcomes, and cost-efficiency.”

The researchers therefore decided to study 234 patients (71% female; mean age, 45.4 ± 13.2 years) who were receiving care at a virtual, multidisciplinary GI clinic called Oshi Health, Inc. Of these, 51% received a new GI diagnosis, mostly DGBI (63%). The study was conducted over a 9-month period.

The virtual clinic “operates under a value-based care reimbursement model, in partnership with national commercial payers,” the authors explained. This means that the clinic is reimbursed through bundled or capitated payments, rather than through fee-for-service billing, thus incentivizing outcomes over volume.

The researchers set out to characterize these patients (eg, their demographics and medical history) and assess their degree of engagement (ie, willingness to enroll, continued participation beyond the initial visit, total number of visits, and average rate of asynchronous messaging between patient and care team).

They also wanted to understand patient-reported outcomes after receiving this care. These were assessed via brief surveys conducted each month (assessing symptom severity and symptom control), each quarter (assessing dysphoria, missed workdays, and productivity), or immediately following clinical visits (assessing satisfaction).

In addition, the researchers compared healthcare utilization and costs between the multidisciplinary virtual program and propensity score-matched control group identified from claims data, using difference-in-difference analyses.

Scalable Solution

Of the patients, 80% met engagement criteria, completing a mean of 10 visits and a median time-to-first appointment of 6 days. Frequently utilized members of the care team were dietitians (93%), followed by psychologists (76%) and healthcare coaches (64%).

Over the study period, engaged patients experienced a significant clinical improvement, including a “clinically meaningful 81-point reduction in IBS symptom severity and a rise in the percentage of patients with symptom control from 20% to 87%,” Varma reported (P < .05 for all).

Moreover, compared with matched control individuals, a significantly smaller percentage of patients required imaging studies (15% vs 44%; P < .0001) and GI-related ED visits (4% vs 10%; P = .0028). In turn, this played a role in lowering costs, with reductions of $443 per member per month in GI-related costs (P = .047) and $676 in all-cause costs (P = .043), which was equivalent to annualized savings of $5,316 and $8,112, respectively.

The authors noted several limitations. The cohort was limited to commercially insured patients from three geographical regions and lacked detailed sociodemographic data (eg, race and household income), so findings may not be generalizable. Selection bias may also be at play — patients who chose to enroll in this type of program may have been “more motivated or receptive” to dietary interventions. And the follow-up period may not have been sufficient to capture long-term outcomes, especially as many GI conditions are chronic and relapsing.

Still, they believe their study demonstrates that virtual multidisciplinary care “offers a scalable solution for practice transformation and healthcare system redesign.”

Varma feels the findings hold important take-home messages for health systems, not only for individual clinicians. “Offering your patients and gastroenterologists access to a multidisciplinary care team is possible through partnerships with virtual care delivery platforms,” she said. “These partnerships have proven to improve patient outcomes and experience, while allowing physicians to focus on needed in-person procedural care.”

Expanding the Reach

Commenting for Medscape Medical News, Brijen Shah, MD, associate dean at Icahn School of Medicine and vice president of medical affairs at Mount Sinai Health system in New York City, called it a “really nicely done study.” The researchers “recruited well and had thoughtful matched controls as much as they could.”

Shah, a professor of medicine and gastroenterology, as well as geriatrics and palliative care, thinks that “what was really great about this model was that it gives patients more access to GI care.” He noted that there is a shortage of gastroenterologists in the US. Moreover, gastroenterologists “tend to aggregate in urban metropolitan areas, so patients that live in a rural area have less access. So to be able to log onto a computer or a device and be able to get that expertise is both really good for patients and also allows health systems to have further reach into the community or their state.”

An additional plus is that dietitians, health coaches and psychologists “still aren’t as plentiful as we need for the number of people with these conditions — even in Manhattan, where I practice, it’s hard to find these resources for people who can benefit from them. So having a team and the ability to access them virtually is really great.”

Grant support for the study was provided by UCSF Rosenman Institute. Optum Labs was the funding sponsor. Varma and Jeffrey Berinstein, MD, MS, reported serving as consultants to Oshi Health. Sameer K. Berry reported being the chief medical officer at Oshi Health and having equity interest in Oshi Health. Shah reported having no relevant financial relationships.

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books.