Almost 100 different autoimmune conditions exist. These diseases often impact many organ systems and are complex, requiring a number of specialists to manage them. “Patients often get lost trying to navigate among specialists,” says Susan Manzi, MD, MPH, chair of Allegheny Health Network’s (AHN) Autoimmunity Institute in Pittsburgh, Pennsylvania. “Unfortunately, specialists often don't communicate optimally with each other, which leads to inefficiency.”
With these challenges in mind, in February 2018 AHN opened the Autoimmunity Institute, the first of its kind in the world, dedicated to caring for patients with autoimmune conditions. The institute brings together 13 different specialists under one roof with expertise in autoimmune conditions. The center’s layout uses huddle halls, which are large open spaces where care teams can communicate and collaborate more easily. This enables them to discuss and implement care plans more effectively.
The care team includes behavioral health specialists, who help manage depression and anxiety; pharmacists who help manage high-risk medications, improve treatment adherence, and help find medication assistance programs for expensive treatments; social workers who identify social determinants of care (e.g., poverty, lack of transportation, food, and housing insecurity) and address them with patients; nutritionists who assist with dietary restrictions and healthy eating habits; and care navigators who help patients navigate through specialist visits and diagnostic testing.
Autoimmune conditions often run in families, so the institute has become a one-stop shop for many families. “We might see a mother with rheumatoid arthritis, maternal aunt with autoimmune thyroid disease, daughter with lupus, and maternal cousin with inflammatory bowel disease,” Manzi says. “In addition to being able to manage all of these conditions in one location, the institute has a large research program and can provide access to new therapies and diagnostic tools.”
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Manzi says autoimmune diseases are probably second to cancer in terms of discovery of new biologic and immune-modulatory therapies. These agents are very expensive, are often given by injection or infusion, and require monitoring. “We are developing pathways for rheumatoid arthritis and inflammatory bowel disease and soon for psoriasis and psoriatic arthritis, so that we can optimize how we treat these diseases,” she says. “When physicians follow best practices it generally results in lower costs and better outcomes for patients.”
By being in an integrative delivery and financing system with its payer (Highmark Blue Cross Blue Shield), AHN can quickly move toward a pay-for-value model instead of volume and show that by standardizing best practices in autoimmunity, it can actually measure how the model impacts hospitalizations, emergency room visits, and total cost of care easily using claims data from Highmark. “We can begin to change how we pay for care and reimburse doctors and hospitals more quickly in this model,” Manzi says. “Since autoimmune diseases are common and account for some of the highest costs to payers, there is great motivation to support new models of care.”
Another autoimmune condition?
Researchers continue to discover new disease processes. Research performed by scientists from MIT and Massachusetts Eye and Ear showed that glaucoma may be an autoimmune disease, the journal Nature Communications reported in August. The study showed that the body’s own immune system can destroy retinal cells and drive glaucomatous neurodegeneration. Gradually, this attack wears away at the retina and optic nerve, causing blindness.
“Clinicians and researchers have long suspected that glaucoma involves more than just intraocular pressure,” says Andrew Iwach, MD, clinical spokesperson for the American Academy of Ophthalmology. “An inflammatory component has been one of the suspects. This study encourages continuing this line of research.”
For most patients, lowering intraocular pressure adequately at least slows down and usually halts glaucoma progression. “However, scientists are continuing to search for evidence for other mechanisms that may play a role that could potentially open up new approaches in treatment,” Iwach says. “If a new mechanism of action is identified, this could open up new therapeutic approaches.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.