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RA Broadly Affects the US Population and Has a Substantial Clinical Burden

Americans are affected by RA1
Up To75%
of patients with early RA show signs of joint damage within 12 to 24 months of disease, and permanent damage to bones can begin within the first year of developing the disease2
patients with RA will require joint surgery to relieve pain and improve functionality3
of patients with RA are forced to stop working within 10 years of being diagnosed due to disability4

The Total Economic Burden of
RA Is High

Total costs to the health care system for RA care, including $8.4 billion in direct costs* and $10.9 billion in indirect costs1,†
Increased cost for RA care versus one of the most common forms of arthritis, osteoarthritis2
The average annual cost of care for RA patients2
$3,500 to $32,0002

Care Gaps: Patient Follow-up After Diagnosis Can Be Improved in RA

of patients with newly diagnosed RA received DMARD therapy during the first year of the disease1

of patients with RA received symptomatic treatment only1

of patients with RA did not see a rheumatologist in year 1 of the disease1


Signs and symptoms of RA develop gradually and are additive and more severe over time3

Improvements in treatment may be related to earlier diagnosis and the use of more aggressive and newer antirheumatic treatment regimens4


Percentage of adults with RA who did not receive appropriate treatment with an antirheumatic drug

Medicare Five Star5

HEDIS® Medicare PPO6

Average 2017 plan Medicare Star Rating7,*

Who Are the Quality Care Stakeholders in RA Health?

CMS 5-STAR (2018)1
Rheumatoid Arthritis Management
NCQA HEDIS® (2018)2
Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
MACRA/MIPS (2018)3
Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis
Rheumatoid Arthritis (RA): Functional Status Assessment Rheumatoid Arthritis
Glucocorticoid Management
Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity
Rheumatoid Arthritis (RA): Tuberculosis Screening

A Case of Improved RA Health–Advocate Medical Group, Northeastern and Central Illinois

The Situation1
A medical group in Illinois that participates in one of the nation’s largest ACOs
More than 250 community-based medical practices and more than 1,200 providers
Serves nearly 750,000 unique patients

In 2014, Advocate Medical Group performed at a 3-star level for PQRS 108 (DMARD use) in the Medicare Advantage population, measured DMARD use inconsistently, and was not capturing data on assessment of disease activity or functional status measures.* Advocate Medical Group planned to bring rheumatology practices together to create opportunities for teamwork and consistency.

The Task1

Advocate Medical Group participated in a learning collaborative with the American Medical Group Association to test approaches and design care processes that improve RA care. Two rheumatologists from 2 practices in different regions convened to:


Standardize the collection of functional and disease assessment measures in the EMR


Identify the best practice workflow to capture these assessments

The Actions1
Leadership involvement & support
  • Full support from the C-Suite for the project was obtained by the Chief Medical Officer
  • A small project team consisting of pharmacy, rheumatology, and quality improvement leadership was convened to develop the project design and participate in the collaborative
  • A larger team, including leadership from EMR, IT, and regional operations, were engaged to support the project
Team collaboration
  • Rheumatologists worked with the EMR team to develop a concise, visual, easy-to-interpret, and longitudinal way to capture and store valuable RA-specific information for the purpose of delivering care
  • Flowsheets within the EMR were created as a single point of reference for rheumatologists to review functional and disease activity assessments, key labs, and preventive care services
Population identification
  • Advocate Medical Group performed a review of EMR-based claims to identify patients with a previous RA claim or who had RA listed on their list of medical conditions
  • The team then piloted 4 workflows to identify the most effective way to capture RA functional and disease activity assessments
  • Methodologies that were reviewed were previsit mailing, office staff call, central call center, and office based
The Results1
  • After implementation, 80% of sites had documentation of disease activity assessments vs 23.5% with the overall baseline*
  • Office-based assessments and previsit mailings were the most efficient and successful methods for obtaining functional and disease activity assessments.