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    New challenges, opportunities in autoimmune disease treatment


    Susan Manzi, MD, MPH, chair of the department of medicine at Allegheny Health Network (AHN), in Pittsburgh, Pennsylvania, is on a mission to improve the education and healthcare needs of those impacted by lupus and other autoimmune disorders.

    Lupus is a chronic, inflammatory, autoimmune disease that can affect virtually any organ system in the body.  It is potentially fatal and there is no cure. Common signs and symptoms include aching joints, skin rashes, chest pain, hair loss, kidney failure, seizures, fevers and fatigue. Lupus can be characterized by periods of illness known as “flares.” But with appropriate treatment, there can be periods of remission or less disease activity.


    “Education is critical—and this includes those impacted with lupus as well as the healthcare professionals caring for them,” says Manzi, who directs the Lupus Center of Excellence at AHN. “We need to teach physicians how to recognize and diagnose the disease, as well as to treat it using best practices.”

    Managed Healthcare Executive (MHE): Why should lupus and other autoimmune disorders be on healthcare executives’ radar screens?

    Manzi: Up to 50 million Americans have an autoimmune disease. That’s one in five people in the U.S. There are more than 80 types of autoimmune diseases.  The ones that are more commonly recognized include:

    ·               Lupus,

    ·               Rheumatoid arthritis (RA),

    ·               Multiple sclerosis, and

    ·               Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s.

    But there are others that many people wouldn’t normally think of as being an autoimmune disorder—such as type 1 diabetes, psoriasis, autoimmune thyroid, celiac, autoimmune hepatitis, and inflammatory eye diseases like uveitis, which is a form of eye inflammation. Interestingly, autoimmune diseases tend to be more common in women, with estimates from 75% to 90% in certain conditions; they are chronic, most have no cure, and other than cancer, can be some of the most expensive diseases to treat. There are many new biological therapies—treatments that target the immune system and prevent the attack on self—that are effective, but costly.  Ensuring that we are using these agents appropriately is important. Often the upfront investment will have major benefit on quality of life and total cost of care.  

    IBD (including Crohn’s disease and ulcerative colitis), lupus, rheumatoid arthritis, multiple sclerosis, and psoriasis, together have an estimated cost of $70 billion per year. These costs are shifting from inpatient hospitalizations to ambulatory drug costs that are keeping people healthy and out of the hospital.

    The good news is that advances made in the treatment of one autoimmune disease can positively impact another. Effective therapies for rheumatoid arthritis also treat Crohn’s disease. Having a uniform approach to the management of autoimmune conditions is ideal. 

    MHE: How is the AHN managing care for patients with autoimmune diseases?

    Manzi: The AHN physician group appreciates the fact that autoimmune diseases are tough to tackle and that a lot of people in Western Pennsylvania struggle with these chronic conditions. They have answered this call to action by supporting the creation of the Autoimmunity Institute. The institute brings together under one roof all of the specialists needed to treat people with autoimmune conditions. This includes, but is not limited to, rheumatologists, gastroenterologists, dermatologists, allergists, endocrinologists, lung and kidney specialists, with wraparound services such as behavioral health, since depression is not uncommon in those impacted by chronic diseases. We will have access to pharmacists who can help with medication adherence and navigators to guide our patients through the healthcare system. We will also be conducting clinical and scientific research in the institute, because access to the latest experimental therapies, novel technologies and new diagnostic tests are important to our patients. This type of care delivery model is not only transformative, but sustainable in a truly integrated delivery and financing system like Highmark Health. The payer is acutely aware of the fact that to tackle the growing cost of healthcare, managing chronic diseases effectively is paramount. 

    One of the ways that AHN and Highmark are working together is by creating pathways and protocols to minimize the unnecessary variation in care.  For example, when you have 10 medications available for the treatment of RA, Crohn’s disease, or ulcerative colitis—providing a roadmap using evidence-based recommendations to guide healthcare providers to the right drug at the right time can be a win-win for our patients, the doctors, and the health plan. 

    Next: The best approaches



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