P0773 - A Mixed-Methods Analysis of the Insurance Experiences of Patients Undergoing Stem Cell Transplantation for Severe Crohn’s Disease

Alicia Philippou, MD¹, David Kohler, MD², Ruhee Shah, MD², Ksenia Gorbenko, PhD², Louis Cohen, MD, MS², Laurie Keefer, PhD^2
1Montefiore Medical Center, Bronx, NY; ²Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Stem cell transplantation (SCT) is a treatment for severe Crohn’s Disease (CD) which has shown promise but implementation can be complex due to insurance barriers. The objective of this study was to qualitatively examine insurance experiences of patients with severe CD who were undergoing stem cell transplantation.

Methods: N=12 patients with severe CD were recruited from a single tertiary care center to participate in a mixed-methods study. They were recruited from a clinical trial in which patients agreed to undergo SCT for management of their CD. There was a multidisciplinary team available to support them through transplantation, including navigating insurance processes. A qualitative semi-structured interview was completed. Interviews were coded independently by 3 coders to identify themes.

Results: Table 1 describes patient demographics. 9 themes emerged from the interviews (Image 1). IBD Themes included: Patients chose to undergo SCT as they had run out of all other treatment options (12 of 12 patients), they experienced trauma due to the severity of their IBD (7 of 12), and subjective quality of life improved after SCT (12 of 12). Insurance themes included: Insurance denials were common and led to delays in care (9 of 12) lasting weeks to over a year, patients experienced trauma (emotional and physical) due to insurance denials (6 of 12), patients were resilient and determined to improve their health (12 of 12), and struggled to navigate insurance processes irrespective of health literacy (11 of 12). Themes highlighting opportunities for improvement included: Patients desired increased transparency in communication with insurance companies (4 of 12) and patients with advocates within insurance companies had better experiences navigating the insurance process (4 of 12).

Discussion: Patients in our study had severe CD and were willing to undergo SCT after enduring years of severe disease as they had run out of treatment options. Due to prior experience with adversity they were resilient, however repeated insurance denials led to significant delays in care and further trauma despite the support of a multidisciplinary team. Patients who described positive experiences with insurance tended to have patient advocates within insurance companies to keep them informed of the approval process. In order to avoid further trauma, insurance companies should consider policy reform to improve transparency of approval processes with the help of insurance-company-based patient advocates.




Disclosures:


Alicia Philippou, MD¹, David Kohler, MD², Ruhee Shah, MD², Ksenia Gorbenko, PhD², Louis Cohen, MD, MS², Laurie Keefer, PhD². P0773 - A Mixed-Methods Analysis of the Insurance Experiences of Patients Undergoing Stem Cell Transplantation for Severe Crohn’s Disease, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.