Incentives for Danish healthcare management based on a pilot outcome-based, patient-centric management model in psoriasis and psoriatic arthritis: the non-interventional IMPROVE study

Abstract

Background Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients’ quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA. Methods The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1–3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark. Results Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important ‘clusters’ of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely. Conclusion The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems. Trial registration Not applicable; data collected from patient registries in Denmark.

A value‐based healthcare model for initiating and switching psoriasis therapies—Results from the prospective multicentre IMPROVE study

“…To test the outcome-based, patient-centred management model, remuneration for treatment of the individual patient was calculated using model B, described by Thomsen et al 7 An expected PASI was calculated for the final visit based on whether the patient was overweight or/and smoking, which are known to worsen PsO and complicate treatment. Based on data from the literature, [8][9][10] the expected PASI was a 30%, 18% or 11% reduction from baseline PASI in patients not overweight or smoking, overweight or smoking, or both overweight and smoking, respectively.…”

“…To test the outcome‐based, patient‐centred management model, remuneration for treatment of the individual patient was calculated using model B, described by Thomsen et al 7 . An expected PASI was calculated for the final visit based on whether the patient was overweight or/and smoking, which are known to worsen PsO and complicate treatment.…”

“…At the interim and final visit, the patients rated to which extent they had experienced an improvement for each of the 25 questions in the PBQ. The Patient Benefit Index (PBI) is the arithmetic mean of all rated benefits (PBQ items) weighted by the relative importance of each corresponding need item (PNQ) for each patient (7), and a PBI ≥1 indicated minimal patient-relevant benefit of treatment. The PBI used in the assessment was transformed from a 4-point Likert scale to a 5-point scale by subtracting 1 and multiplying with 4/3.…”

Non-pharmacological interventions for patients with psoriasis: a scoping review

“…Patients suffer from skin damage and physical and mental disorders due to damaged skin integrity, embarrassment, inferiority complex, anxiety and depression, affecting their psychology, social life and work 7. Psoriasis has undoubtedly become a serious public health concern due to the impairment of quality of life (QOL) 8 9…”

“…A national plan led by the German Psoriasis Network (PsoNet) was initiated to improve the quality of care in patients with psoriasis 13. An IMPROVE model was established in Denmark for patients with psoriasis and articular psoriasis to ensure they get the best care and eliminate inappropriate incentives in the current compensation system 9. Notably, many non-pharmacological interventions, such as multidisciplinary teams,6 14 15 educational interventions (therapeutic patient education, psychoeducational intervention and self-management education),2 6 14–40 psychosocial interventions (cognitive and behavioural treatments, self-help and peer-to-peer (P2P) support programme)6 15 18 22 24 41–55 and others (happify and motivational interviewing-based training) have proven to be effective 44 56…”