Navigating the payer-provider maze to individualize IBD management

Program overview

Patients with inflammatory bowel disease (IBD) are significant users of healthcare resources, representing over 1.8 million visits to ambulatory care and over 75,000 visits to ER each year. Although the traditional treatment algorithms for Crohn's disease (CD) and ulcerative colitis (UC) are "stepwise" there is increasing recognition that an individualized approach to management, including "treatment to target" and optimization of therapy, while involving the patient as an active participant in care, improves patient satisfaction and treatment outcomes, including reduced healthcare resource use. This "individualized approach" can be applied at different stages of management, however, on discussion with our IBDWG faculty, and review of different managed care organization policies, several potential barriers to implementation exist.

These barriers include;

  • Limitations on the use of repeated endoscopy
  • Denied reimbursement of antibody testing
  • Restriction of biologics to patients with "documented refractory disease" (leading to delay in initiation)
  • Restriction to a specific anti-TNF (limiting patient choice/individualization of therapy)
  • Requiring failure of multiple anti-TNF therapies (even in primary non-responders) before making alternative therapies (e.g., anti-integrins) available (leading to delay in initiation in patients unlikely to respond to anti-TNF).

To address these barriers it is important to understand which aspects physicians find most "time consuming", and therefore most likely result in a failure to apply optimal therapy in clinic. This survey-driven activity will focus on those aspects which physicians find most troublesome/time consuming.

Target audience

This activity has been designed to meet the educational needs of gastroenterologists who are responsible for the care of patients with inflammatory bowel disease (IBD). Other physicians who care for patients with IBD may also find the content of use.

Release date: February 17, 2016
Expiry date: February 17, 2017

Learning objectives

After completing this activity, the participant should be better able to:

  • Describe the information considered by managed care organizations and insurers to develop a formulary and reimbursement strategy
  • Explain how treatment for inflammatory bowel disease (IBD) needs to be individualized to improve patient satisfaction and outcomes
  • Compare approaches and systems for providing information to payers to request funding for therapies or tests for patients with IBD
  • Develop strategies to ensure that IBD patients have appropriate access to tests and therapies which will provide the best possible opportunity for long-term remission.


Professor of Medicine
Bowel Disease Center
Section of Gastroenterology
University of Chicago Medical Center
Chicago, IL


Sandra C. Kim, MD
Pediatric Gastroenterology
Co-Director, Center for Pediatric and Adolescent Inflammatory Bowel Disease
Nationwide Children's Hospital
Columbus, OH


Lawrence R. Kosinski, MD, MBA, AGAF, FACG
Managing Partner
Elgin Gastroenterology
Illinois Gastroenterology Group
Elgin, IL


Linda Kulig, RN, BSN, CGRN
Nurse Associate
Inflammatory Bowel Disease Center
University of Chicago Medicine
Chicago, IL


Syllabus disclosure statement

Disclosure of conflicts of interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter

Reported Financial Relationship

David T. Rubin

Consulting fees: AbbVie, Amgen, Emmi, Genentech, Janssen, Pfizer, Prometheus Laboratories, Santarus/Salix, Shire, Takeda, Telsar Pharmaceuticals, UCB Pharma

Grant support: AbbVie, Genentech, Janssen, Prometheus Laboratories, Shire, Takeda, UCB Pharma

Other: Cornerstones Health Inc.

Sandra C. Kim

Consulting fees: Abbott Laboratories, AbbVie

Lawrence R. Kosinski

No conflicts to declare

Linda Kulig

No conflicts to declare

The planners and managers reported the following financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity:

The following PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, RN, BSN, and Jan Schultz, RN, MSN, CHCP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following SCI planners and managers, Ian Morgan, MSc, and Elena Urso, BSc, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity or any amount during the past 12 months.


Physician continuing education

Accreditation statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and Strategic Consultants International. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Estimated time to complete activity: 45 minutes

Disclosure of unlabeled use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Method of participation and request for credit

There are no fees for participating and receiving CME credit for this activity. To successfully earn credit, participants must complete the activity online during the valid credit period. Follow these steps to earn CME credit:

  1. Read the target audience, learning objectives, and author disclosures
  2. View the educational content online
  3. Upon completion of the activity, complete the online posttest and Activity Evaluation to provide feedback for future programming.

Upon successful completion of the posttest, with a score of 75% or better, and the online Evaluation form, you will have immediate access to a certificate of attendance to print or save for your files.

If you have any questions regarding the CME certification for this activity, please contact Postgraduate Institute for Medicine at: or (303) 799-1930.

Media: Internet


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Jointly provided by the Postgraduate Institute for Medicine and
Strategic Consultants International
PIM Logo  
This activity is supported by an independent educational grant from
Takeda Pharmaceuticals International, Inc., US Region.