From NEJM Catalyst
Thanks to the revolution in biologic therapy, the annual number of intravenous infusions at the Massachusetts General Hospital (MGH) rheumatology clinic’s small (two-chair) infusion center increased from 1,247 to 1,856 between 2009 and 2014. Related billings skyrocketed from nearly $16 million to more than $40 million. To understand this major shift, one must pause briefly to appreciate the medical history that led to it and then to examine how MGH is redesigning its care processes to bring these novel therapies to patients. Central to the plan is a collaboration with academic partners at the MIT Sloan School of Management.
The Medical Backstory
In 1980, a rheumatoid arthritis (RA) patient at the MGH rheumatology clinic would have received a weekly in-clinic infusion of gold salts and, occasionally, undergone laboratory monitoring.
In 1995, that same patient would get a handwritten prescription for 6 to 10 tablets of methotrexate and instructions to return for blood work several times a year. By 2010, the patient would probably have received a biologic agent, administered intravenously.
This sea change for patients with many types of rheumatologic disease (not just RA) has been astonishing: arthritic joints relieved, kidneys and eyesight saved, vasculitis flares prevented, all with substantially lower cumulative doses of glucocorticoids and fewer conventional immunosuppressive drugs than patients used to receive.
Retsef Levi is the J. Spencer Standish (1945) Prof. of Management; Prof. of Operations Management and Co-Director of the Leaders for Global Operations Program.