See Part 1 for how Bonnie met Bill Conlan pre-CrossBridge and for background on his entrepreneurial track record. That background includes SaaS platforms, analytics and the migration from fee-for-service (FFS) to value-based payments (VBP). Part 1 also lays out the challenges Bill saw for specialty practices in chronic disease management. These are particularly challenging in rheumatology, especially in chronic inflammatory diseases (CIDs), including autoimmune and autoinflammatory diseases.
Bill’s Eureka! moment
Bill’s experience in VBP analytics, plus with rheumatology practices as an Ankylosing Spondylitis (AS) patient, prompted him to address this tough unmet need in chronic disease management. Everywhere he saw costly & inefficient care pathways, lack of coordination, frustrated patients & providers, unsatisfactory care outcomes and increasing costs. Patients are frequently undertreated, often have difficulty managing their medications, or simply give up and are lost to care. Practices underuse evidence-based care (EBC), nor do they make the most of measurement tools for monitoring disease progression and remission. All of this leads to more serious disease, worsening patient outcomes and high-cost emergency treatment and hospitalization.
Analyzing the problem
What causes this? Misaligned payer-provider incentives, a shortage of rheumatologists, inadequate patient follow up, complex care pathways with hand-offs between primary care and specialists. Most importantly, there is a lack of analytics to uncover and quantify waste in the patient journey. Furthermore, the migration from FFS to VBP towards value-based care (VBC) has been especially challenging (although potentially very valuable) for payers and practices treating chronic diseases.
Therefore, Bill’s background in VBP and analytics led him to found CrossBridge. The goal: to better manage chronic disease care through a solution delivered on a Software-as-a-Service (SaaS)5 platform. The product better aligns incentives between practices and payers by helping specialists make better use of EBC guidelines, measurement tools and treatment feedback. The platform also helps coordinate more effectively with other specialists and primary care practices. This not only improves practice process efficiency, reduces waste and lowers costs, but also patient outcomes and satisfaction, a win-win-win for all parties.
How CrossBridge addresses the challenges
CrossBridge’s SaaS platform automates evidence-based guidelines through a rules engine that guides, tracks and evaluates care. This CCIT (care coordination information technology) platform also reduces practices’ administrative burdens and makes it easier for practices and payers to find and eliminate waste. To avoid cumbersome pre-authorization and administrative hassles, practices agree to follow the guideline pathways. CrossBridge is designed to serve as an independent intermediary to measure compliance against the pathway model. The rules-based engine for each disease combines expert recommendations with financial incentives to follow the guidelines and get the best results for patients.
CrossBridge SaaS platform enables the smooth flow of clinical and cost data from payer to any specialist provider who cares for patients with complex inflammatory diseases. Furthermore, the platform is scalable from providers to multiple payers. This easy-to-use, transparent platform simplifies migration to VBP and VBC.
Rheumatology and beyond
CrossBridge’s initial focus on rheumatology reflects not only Bill Conlan’s experience as an AS patient, but also the fact that rheumatology practices see more CID patients than any other specialty. Rheumatoid Arthritis (RA) is the most familiar, but many other inflammatory conditions affect joints. Ankylosing spondylitis (AS) is the most prevalent of a family of spondyloarthritis diseases. This group also includes Psoriatic Arthritis, associated with the skin disease psoriasis, and Enteropathic Arthritis, associated with Inflammatory Bowel Diseases (IBD). Since psoriasis is managed by dermatologists and IBD by gastroenterologists, that calls for more specialist coordination to manage these patients.
CrossBridge focuses on an array of diseases, because their customer is the payer, looking to scale multiple diseases and specialty types. Payers are frustrated with buying multiple disease-specific solutions, especially for low-prevalence diseases. Managing and integrating multiple apps, monitoring devices, etc. is costly for them. Therefore, CrossBridge plans to expand its platform into gastroenterology, neurology, dermatology and other specialties that serve chronic inflammatory disease patients.
Future challenges for CrossBridge
Long-term case management
Not just medication adherence, but managing doses, combinations, switching or adding drugs, before patients deteriorate or side effects get out of control. The concept of beta, a measurement of risk borrowed from finance, can be helpful here since the high cost of specialty medications increases the risk of costly mistakes. However, so do unanticipated costs like emergency treatment or hospitalization for patients whose conditions deteriorate unnoticed.
More effective use of primary care & coordinating specialists
Better use of PCPs (primary care physicians or practices) is particularly important in specialities such as rheumatology, where a shortage of physicians is a constraint on clinical care. If more patients can be managed through their primary care practices this relieves some of the burden on specialists. Payers, following CMS, are currently applying VBC models to specific procedures such as orthopedics (knee and hip surgery), which are definable episodes of care with primary care as a gatekeeper. ACO (accountable care organization) VBC models manage patient populations and subpopulations through PCP networks or across their systems. CrossBridge comes into play as primary care moves towards a VBC model. When and how do they refer out to a specialist? PCPs can work with CrossBridge to provide them specialist referral networks.
These are modalities like exercise, diet, oral health and trigger avoidance that likely benefit patients. However, conventional clinical practices generally ignore these approaches. This is because the path from observational experiments to peer-reviewed studies to evidence-based care (EBC) guidelines takes years. This, plus the convenience of prescribing specialty meds have suspended conventional clinical interest in non-drug interventions, which require time-consuming (and unprofitable) clinical coaching and ongoing patient cooperation to work. This has been an opportunity for alternative and functional medical practices, who follow different lines of evidence, not always as robust, but usually much faster.
Lifestyle modifications and VBC
For example, consider lifestyle modification. Draft ACR guidelines in 2020 for AS include three simple “low-quality evidence” recommendations about exercise. And that’s it. But, as Bill learned from his own experiments, and as functional practices have preached for years, exercise is more important than drugs to prevent immobility and deformity in AS patients. Exercise, PT, diet, oral health, and trigger avoidance could support robust remission and reduce the use of specialty medications. This is true only if payers reimburse practices for these modalities. That means building an evidence base and changing reimbursement policies.
What’s next for CrossBridge
Bill Conlan told us that next for CrossBridge is expanding the model into additional specialties: gastroenterology, neurology, dermatology and beyond. Each specialty presents somewhat different payer, practice and patient issues.
GI practices lean heavily on endoscopic procedures for revenue, but that puts them at risk for changes in guidelines, reimbursement and patient preference that may impact cancer colonoscopy screening demand.
Dermatologists have split into two major models: Consumer-paid (FFS) high-margin cosmetic specialists and conventional dermatology practices that treat chronic conditions like eczema and psoriasis. Psoriasis, like other chronic inflammatory diseases, presents familiar issues such as high-beta risk, long-term patient management and specialty medication costs. Further, psoriasis overlaps with psoriatic arthritis, so two specialist practices are often involved.
Neurologists treat many chronic conditions, including autoimmune diseases like multiple sclerosis (MS), that present similar coordination challenges. MS in particular uses many expensive diagnosis and monitoring procedures as well as a large number of specialty drugs, which complicates treatment pathways and increases risk.
The CrossBridge platform can readily be adopted to meet the particular challenges of each specialty, and can help bridge the gaps between primary care and multiple specialists involved in managing chronic disease patients’ long-term care.
The pandemic is an opportunity for CrossBridge
Bill & Bonnie’s visit to Allegheny Autoimmune Institute was inspiring in what it suggested about the value of team collaboration in specialty chronic care. But the COVID-19 pandemic has shattered the collegial work environment that centers of excellence have used to improve care. This highlights the need to create data infrastructures that help specialists collaborate virtually to better manage chronic inflammatory disease patients.
Payers’ & providers’ views of innovation under COVID-19
An unexpected pandemic side effect is that payers are currently reluctant to invest in any kind of innovation. On the other hand, medical specialists now have more time on their hands to investigate and adopt new approaches. Changes set off by the pandemic and the healthcare system’s response, are accelerating the migration to value-based care (VBC). However, this highlights how better IT tools and platforms are needed to support and facilitate this migration.
Telemedicine is here to stay
The sudden surge in telemedicine, some version of which is likely here to stay, also offers opportunities to make big changes in care coordination. For example, using nurse practitioners, coaches and other less-scarce experts as points of coordination could lighten the burden on rheumatologists and other scarce specialists, without threatening their practice models. Patients, too, are increasingly comfortable with virtual visits, remote monitoring and tracking apps.
Digital platforms for a changed future
Early adopter (thought leader) partners, specialists and payers are changing payer models to incentivize specialists. Digital platforms can enable guiding practices and patients more efficiently along complex care pathways. They also can help coordinate specialists and primary care practitioners by easing communications about what each is doing for and seeing in patients. All this means a time of opportunity for CrossBridge.
By Bonnie Feldman and Ellen M Martin
Part of our series of B2B thought leadership interviews with visionary entrepreneurs and executives of companies applying digital tools to improve care of chronic immunoinflammatory diseases. We write these from our two different multi-lens perspectives. DrBonnie360: clinical dentist, Wall Street analyst, patient advocate, and digital health consultant. Ellen M Martin: life sciences, finance, marketing, IT, corporate communications and writing/editing.
How to contact CrossBridge
CrossBridge offers the most comprehensive Software as a Service (SaaS) solution available to help payers improve outcomes and lower costs of treating chronic inflammatory diseases (CIDs). These include such chronic autoinflammatory and autoimmune diseases as rheumatoid and psoriatic arthritis, the spondyloarthroses, inflammatory bowel diseases and multiple sclerosis. Supported by clinical advisory boards of leading specialist physicians and researchers, CrossBridge is an unparalleled resource for conquering complex disease. Go to the CrossBridge main site at https://crossbridge.com or to their contact page. For more information on Bill Conlan, see his LinkedIn page.
DrBonnie360: more than Your Autoimmunity Connection
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