Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide

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Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
Cardinal Health Specialty Solutions

Rheumatology Insights:
October 2021
Views on industry trends impacting rheumatology practices nationwide
Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
A message from the president

    Heidi Hunter

    Welcome to our second annual edition of Rheumatology Insights, a
    research-based report designed to provide perspectives on key issues
    and trends affecting rheumatology practices nationwide.
    As someone who has spent a good portion of her career working in
    rheumatology, I’ve seen firsthand how this therapeutic area has changed.
    Over the past decade, the demand for rheumatology care has grown
    steeply as the population has aged, while at the same time, the pressures
    and complexities facing rheumatology practices have increased.
    Our new report seeks to understand how rheumatologists are managing
    these changing dynamics. We explored their perspectives on the impact
    of COVID-19, how new reimbursement policies are affecting clinical
    treatment and practice operations, and the role that technology and AI
    may play in the future of rheumatology care.
    The research shared in this issue was fielded using web-based surveys
    from July through September 2021. Nearly 90 rheumatologists from a
    mix of community- and hospital-based practices throughout the U.S.
    participated in the research.
    At Cardinal Health, we believe that understanding the needs of
    healthcare providers is key to the delivery of better patient care. We hope
    you find the insights in the enclosed report to be as valuable as we do.
    Sincerely,

    Heidi Hunter
    President, Cardinal Health Specialty Solutions

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Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
COVID-19

                          At the time our first Rheumatology Insights
                          report was published in June 2020, COVID-19
                          was widely viewed as an acute health crisis
                          that healthcare providers and patients would
                          need to manage through for several months
                          until healthcare could return to “normal.”
                          Today, as the U.S. continues to wrestle with new variants of the virus and resurging
                          infection rates, there is broad consensus that COVID-19 will have long-term
                          implications on how healthcare is delivered across all therapeutic areas.
                          The evidence of COVID-19’s impact on rheumatology was clearly seen during the 2020
                          American College of Rheumatology (ACR) conference, in which numerous abstracts
                          examined how rheumatologists’ use of telemedicine has evolved,1 and several posters
                          explored how smartphone apps have been used to support telemonitoring of
                          rheumatic disease activity2 during the pandemic.
                          As COVID-19 continues to create challenges for rheumatology practices, we were
                          curious to understand rheumatologists’ views on the long-term implications of virus,

    Assessing the
                          and to know how patient needs and care protocols have changed. We also wanted
                          to learn whether the pandemic is continuing to impact the financial and operational
                          performance of rheumatology practices.

    impacts of COVID-19
    on rheumatology
    practices and
4
    patient care                                                                                                            5
Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
COVID-19 has shifted the paradigm of care for rheumatologists                                                                                                               COVID-19

    OUR VIEWPOINT
                                                                                   FINANCIAL IMPACT: More than four in 10 rheumatologists
    Gordon K. Lam, MD, FACR                                                        surveyed said the financial health of their practices is not as strong
    Medical Director, Clinical and Translational Research                          as it was before the pandemic, though new patient referrals are
    Arthritis & Osteoporosis Consultants of the Carolinas
                                                                                   stable or increased.
    The responses to our COVID-19 survey questions reflect the important
    impact the pandemic has had on rheumatologists and their patients over         Which of the following best describes the financial health of your practice today?
    the past year and a half. The adoption of telemedicine services is perhaps
    most notable. According to our survey, only 15% were using telemedicine        The financial health of our practice is about the same today as it was before the pandemic
    services before the start of the pandemic, but almost all practices adopted
    in 2020, and more 93% of surveyed respondents say they expect some                46%
    portion of patient visits will continue to be managed via telemedicine after
                                                                                   The financial health of our practice is not as strong today as it was before the pandemic
    the end of the pandemic.
    Although all rheumatologists would probably agree that in-person                  43%
    patient visits are always preferrable to virtual appointments, telemedicine
    has enabled rheumatologists to maintain continuity of care during the          The financial health of our practice is better today than it was before the pandemic
    pandemic, has provided a way to see patients who might not otherwise be
    able to receive care, and has created a new mechanism for reimbursement.          12%
    An overwhelming majority (96%) of survey participants said they expect
    to use telemedicine to see patients who lacked transportation, 46% would       N = 87

    use it to see immuno-compromised patients, and another 41% expect to
    use it to triage patients in emergency situations.
                                                                                   Which of the following best describes your new patient referral volume today compared
    In regard to new patient volume, 79% of surveyed rheumatologists say           to pre-pandemic?
    they are seeing the same amount or more patients than they did before
    the pandemic, while 21% say they are seeing fewer patients. The 21%            We are seeing similar levels of new patient referrals as before the pandemic
    is surprising given that demand for rheumatology services nationwide
    has continued to increase. This may reflect the continued impact of               43%
    COVID-19 and could suggest that some patients may be continuing to
    delay healthcare needs that are not viewed as urgent – or that referring       We are seeing more new patient referrals today than before the pandemic
    physicians are simply too busy treating COVID patients to refer patients for
    other types of treatment.                                                         37%
    One important trend that is not reflected in the research is how               We are seeing fewer new patient referrals today than before the pandemic
    rheumatology treatments may shift due their possible interaction with
    vaccines. Research has shown that several commonly used treatments,               21%
    such as methotrexate, rituximab, and mycophenolate, may affect a
    patient’s humoral response to the COVID-19 vaccine9. These findings            N = 87
    may affect rheumatologists’ treatment decisions, as well as their
    recommendations on the timing of the vaccine doses10. Clearly, this will
    be an important trend to watch over the coming months.                                                            80% of participating rheumatologists
                                                                                                                      said new patient referrals are the same or greater
                                                                                                                      than before the pandemic.

6                                                                                                                                                                                          7
Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
COVID-19                                                                                                                                                                                     COVID-19

       TELEMEDICINE: Nearly two-thirds of participating rheumatologists                                 For what purposes will you use telemedicine in the future?
       said the pandemic caused them to adopt new approaches they will                                  To see patients who lack transportation to appointments                                  90%
       continue to use long term, such as telemedicine.                                                 To see patients who are immunocompromised                                                46%
       Which of the following most aligns with your view on how the COVID-19 pandemic                   To triage patients who may need emergency care                                           41%
       impacted patient care in your practice?
                                                                                                        N = 87
       The pandemic led us to adopt new approaches to patient
       care, some of which we will maintain over the long term                                  58%

       The pandemic had a temporary impact on how we
       treated patients, but it has not had a long-term impact                                  39%

       The pandemic had very little impact on patient care
                                                                                                  3%
       N = 87

       Before the COVID-19 pandemic, what percentage of your patient visits were conducted
       via telemedicine? After the end of the pandemic, what percentage of your patient visits
       do you anticipate will be conducted via telemedicine?

                                                                                      Before pandemic

                                                                                      After pandemic

                                                             3%
        84%         7%            10% 45%                            26%   1%   14%   1%        8%                                While few practices were using telemedicine before the pandemic,

       N = 87
                0                      1-10%                     11-20%     21-30%     31% or more
                                                                                                          93%                     93% of participating rheumatologists
                                                                                                                                  said they will continue to use it in the future, particularly with
                                                                                                                                  patients who lack transportation to appointments.

8                                                                                                                                                                                                           9
Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
COVID-19

     IMPACT ON PATIENT CARE: Over 90% of rheumatologists surveyed
     said the social and economic challenges posed by COVID-19 have
     negatively impacted patients, with mental health support cited as
     the most pressing unmet patient need.

     Please indicate your degree of agreement with this statement. Social and economic
     challenges created by the COVID-19 pandemic (including higher unemployment, social isolation,
     etc.) have had a negative impact on the health of my patients.

     N = 87

         31%                     59%                        9%             1%            0%
        Strongly agree               Agree                 Neither agree   Disagree   Strongly disagree
                                                           nor disagree

     What gaps or unmet needs in patient care have been revealed by the COVID-19
     pandemic? Please select all that apply.

     Mental health support                                                                       83%

     Medication adherence support                                                                61%

     Support navigating insurance coverage/managed care                                          55%

     Support with managing the cost of their therapy                                             52%

     Caregiver support                                                                           43%

     Other                                                                                         5%

     I do not see any significant gaps/unmet needs in patient care                                 1%

     N = 87

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Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
INDUSTRY DYNAMICS

                         Although the COVID-19 pandemic created
                         unique challenges for rheumatology
                         providers, the landscape for rheumatology
                         practices has also been complicated by
                         new clinical developments and changes in
                         reimbursement policies.
                         The continuing shift from fee-for-service reimbursement to value-based reimbursement has
                         been a significant challenge for rheumatology practices for several years, as demonstrated
                         by our 2020 Rheumatology Insights survey. This year, to add to the complexity, the Centers
                         for Medicare & Medicaid Services (CMS) released a new ASP calculation methodology for
                         self-administered drugs,3 resulting in reimbursement decreases for several therapies that are
                         commonly prescribed by rheumatologists.
                         At the same time, rheumatologists are seeing shifts in the mix between infused therapies
                         and oral therapies. This impacts reimbursement because infused medicines are purchased
                         on a “buy and bill” model, meaning providers are reimbursed for the average sales price
                         of the therapy plus 6%. During the COVID-19 pandemic, some rheumatologists shifted
                         immunocompromised patients to oral therapies to avoid unnecessary clinic visits. However,
                         a new FDA black box warning on some oral therapies for arthritis4 and recent shortages of
                         other medications5 may result in a shift back to infused medicines.
                         Our survey sought to understand how rheumatologists are thinking about these issues, and

     Responding to
                         what steps they are taking to help their practices respond to the challenges.

     changing industry
     and reimbursement
12
     dynamics                                                                                                            13
Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
Declining reimbursement continues to challenge rheumatologists,
     and many do not have a plan for replacing lost revenue                                                                                                          INDUSTRY DYNAMICS

     OUR VIEWPOINT
                                                                                    CRITICAL CHALLENGES: Value-based care and changing
     Gordon K. Lam, MD, FACR                                                        reimbursement models were cited as the biggest challenges
     Medical Director, Clinical and Translational Research                          facing rheumatology practices, with the growing demand for
     Arthritis & Osteoporosis Consultants of the Carolinas
                                                                                    care among an aging population and the growth of oral therapies
     The rheumatology landscape has shifted over the past year – but the results
                                                                                    among key concerns.
     of our survey show the rheumatologists’ perceptions about challenges are       As you think about your practice, which of the following do you consider to be the biggest
     largely the same as they were in 2020 with value-based care and changing       challenge facing your practice?
     reimbursement viewed as the top challenge by 28% of respondents vs. 29%
     in 2020. Interestingly, fewer survey participants said they see increasing
                                                                                       2021        2020
     administrative duties as a top challenge: 24% in 2021 vs. 33% in 2020.
                                                                                    N = 87
     Although declining reimbursement is seen as a top challenge, it is not clear
     that many rheumatologists have a clear plan on how to effectively respond
     or counteract the trend. More than 59% said reimbursement changes
     to self-administered drug products would have a significant negative or
     somewhat negative impact on their practice, yet more than a third of
     respondents (38%) said they were either unsure how they would mitigate
     the impact or would not take steps to mitigate.
     The survey also indicated that many rheumatology practices may be
     missing opportunities to strengthen their financial performance by adding
     new revenue streams. Expanding infusion services to therapeutic areas
     outside of rheumatology has become an increasingly recognized revenue-
     generating strategy for many practices, yet nearly half of our participants
                                                                                             28%              29%           18%               15%            24%                33%
     said they infuse rheumatology patients only (48%) and another 14% said          Value-based care and the changing   Lack of providers to support the   Increasing administrative and
     they do not have an infusion center.                                                reimbursement landscape           growing number of patients        practice management duties
     Perceptions about the impact of oral therapies on rheumatology practices
     was mixed with 28% saying they do not expect much impact, 46% saying
     they expect to do fewer infusions, and 26% saying they are unsure what
     the impact will be. While research shows that patients prefer oral therapies
     over infused therapies11, the recent FDA announcement about black box
     warnings for JAK inhibitors12 and the shortage of tocilizumab due to the
     pandemic surge13, both of which occurred after this survey was completed,
     will likely affect rheumatologists’ treatment decisions in the near term.
                                                                                             10%               8%           15%               10%             5%                  5%
     On the whole, the survey results indicate that rheumatologists and their
     administrators may need to put more focus on revenue management to                       Increasing healthcare         Lack of time to spend on                Competition
     maintain financial performance, as reimbursement pressures are likely to                   costs for patients                patient care
     intensify in the future.

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Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
INDUSTRY DYNAMICS                                                                                                                                                                                     INDUSTRY DYNAMICS

        As the U.S. population ages, demand for rheumatology services is expected to grow while                     A growing number of oral therapies for rheumatology are in the drug development pipeline.
        the number of practicing rheumatologists is expected to decrease. How does your practice                    As more oral therapies come to market, how do you see your practice changing?
        expect to manage these changing dynamics? Please select your top 3.

                                                                                            2021        2020

                                                                                       N = 87

                                                                                                                           37%                        28%                       26%                              9%
                                                                                                                    We expect to perform fewer     We do not expect any     I am not sure how more      We expect to perform fewer
                                                                                                                    infusions and subcutaneous     major impact over the   oral therapies will impact   infusions and subcutaneous
                                                                                                                    injections and expect to see    next several years            my practice            injections and will explore
                                                                                                                                                                                                          in-practice dispensing or
                                                                                                                        a decrease in revenue
                                                                                                                                                                                                        adding a specialty pharmacy

           47%          57%           31%          20%        32%          34%            30%          34%
           Hire more advanced            Hire more            Expand patient care        Invest in technology/
           practice providers/        administrative staff     with telemedicine       tools to enable providers
             clinicians (APPs)                                                          to spend more time on
                                                                                              patient care

           16%          14%           15%          23%        10%           8%              8%         11%
         Extend hours to provide      Postpone retirement    Use consulting services   Sell or merge the practice
       patient services on evenings                            to aid with practice
            and/or weekends                                       management

                                 of participating rheumatologists said they plan                                                              More than four in 10 participating rheumatologists said
                 15%             to postpone retirement due to the demands                                                                    they expect to perform fewer infusions and injections
                                 of an aging patient population.                                                                              as more oral therapies arrive on the market.
16                                                                                                                                                                                                                                     17
Rheumatology Insights: October 2021 - Cardinal Health Specialty Solutions - Views on industry trends impacting rheumatology practices nationwide
INDUSTRY DYNAMICS                                                                                                                                                                            INDUSTRY DYNAMICS

        DECLINING REIMBURSEMENTS: About 60% of rheumatologists                                                 This year, the Centers for Medicare & Medicaid Services (CMS) announced reimbursement
                                                                                                               changes for certain Medicare Part B drugs (such as Orencia® and Cimzia®) that have self-
        surveyed said reimbursement has declined, though some have                                             administered formulations. How much of a negative impact will this adjustment have on
        adapted by adding new sources of revenue.                                                              your practice this year?

        Which of the following best describes your view of the reimbursement landscape
        in rheumatology?

                                                               14%
                 47%                   37%                                                  2%
         Reimbursement for my
        practice has declined over
                                     We have not seen a
                                     significant change
                                                            Reimbursement has
                                                          declined, but my practice
                                                                                      Reimbursement for my
                                                                                      practice has increased
                                                                                                                  20%                      39%                       17%              12%             13%
               the past year         in reimbursement       has counterbalanced         over the past year
                                                          these changes by adding                                  Significant              Somewhat                   Very little    No impact        Not sure
                                     over the past year
                                                           new sources of revenue                                                                                   negative impact
                                                                                                                 negative impact          negative impact
        N = 87

                                                                                                               N = 87

                                                                                                               What strategies will you implement to mitigate this negative impact? Please select all that apply.

                                                                                                               Explore other new revenue streams                                                              33%
                                                                                                               Start new patients on different drug therapies                                                 27%
                                                                                                               Move existing patients to different drug therapies                                             23%
                                                                                                               I do not anticipate making any changes to mitigate the impact                                 20%
                                                                                                               Unsure                                                                                         18%
                                                                                                               Change my payer mix/Limit the number of Medicare patients                                      11%

                                                                                                               N = 87

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INDUSTRY DYNAMICS                                                                                                                                                                                            INDUSTRY DYNAMICS

        MULTI-SPECIALTY PRACTICES: About one in three rheumatologists                                                   PATHWAY PROGRAMS: Only about one in four rheumatologists
        surveyed said they care for patients treated for other diseases,                                                surveyed said their practices participate in commercial payer or
        primarily to address community need.                                                                            health plan-sponsored pathway programs, but 22% said they are
                                                                                                                        considering it for the future.
        Which of the following best describes your current practice?
                                                                                                                        Does your practice participate in any commercial payer or health plan-sponsored
                                                                                                                        pathway programs?

                                                                                                                                 62           %                           24             %                    14           %

                                                                                                   5%
                 46%                    35%                          15%
                                                                                                                         No, we do not currently participate        Yes, we currently participate in   No, but we plan to participate in
         We infuse rheumatology    We are a multi-specialty      We don’t have our own         We currently infuse             in pathway programs                        pathway programs             pathway programs in the future
              patients only       infusion practice, infusing   infusion center; we refer    rheumatology patients
                                   both rheumatology and         our patients to a multi-   only, but are considering
                                                                                                                        N = 87
                                                                specialty infusion center     expansion into other
                                   patients treated for other
                                                                                                   specialties
                                           diseases
        N = 87

                          83% of                                                   “Supports a need in
                          rheumatologists                                           my community” (35%)
                          with multispecialty                                       was the most cited reason
                          practices said they                                       for expanding into other                                                   Among practices in pathway programs,
                          provide infusions for                                     specialties.                                                               participating rheumatologists
                                                                                                                                                               cited limited availability of programs (28%), finding
                          gastroenterology
                                                                                                                                                               the patients to participate (26%) and managing data
                          patients.                                                                                                                            and reporting (20%) as the biggest challenges.
                          Dermatology (47%),
                          immunology (43%) and
                          neurology (40%) were
                          also commonly cited.

20                                                                                                                                                                                                                                         21
AI / MACHINE LEARNING

                         As the industrywide shortage of rheumatologists
                         continues to challenge both patients and
                         providers, there has been increased focus on the
                         role that technology and artificial intelligence
                         (AI) can play in reducing the resources burden
                         and helping to support diagnosis and patient
                         treatment decisions.
                         The 2020 American College of Rheumatology meeting featured several abstracts and posters
                         exploring the use of technology in practice, including studies using AI-driven methodologies for
                         X-ray data analysis6 and a study that examines whether machine learning can more effectively
                         identify clinical features and biomarkers to predict response to key treatments.7
                         In addition, as remote monitoring of rheumatology patients has become more common during
                         the COVID-19 pandemic, some researchers are studying the role that digital health technology,
                         such as wearables and apps, can play in supporting better health.8
                         The emerging research around these technologies and the early adoption of AI-based tools in
                         other therapeutic areas suggests there could be a significant opportunity to use AI to enhance
                         care of rheumatology in the future. Our survey is intended to gauge whether rheumatologists are
                         following these technology trends and if they see the same potential for AI in the years ahead.

     Technology use
     and the future
     outlook for AI in
22
     rheumatology                                                                                                           23
Rheumatologists lack familiarity with artificial intelligence and
     machine learning and are skeptical about the value of these tools                                                                                                      AI / MACHINE LEARNING

     OUR VIEWPOINT
                                                                                           CURRENT TECHNOLOGY USE: Nearly all rheumatology practices
     Amy Valley, PharmD                                                                    surveyed use electronic health records (EHRs), and participating
     Vice President, Clinical Strategy and Technology Solutions, GPO                       rheumatologists said they are likely to make further investments in
                                                                                           EHRs in the coming year.
     Advances in technology may have the potential to significantly alleviate              Which of the following technology solutions do you currently use in your practice? Which
     some of the pressures facing rheumatologists. Yet our survey shows most               of the following technology solutions do you expect to invest in during the coming year?
     rheumatologists have low awareness of these innovations and limited                   Please select all that apply.
     confidence in the ability to drive change.
     Despite increased use of artificial intelligence (AI) in rheumatology, more           Electronic health records
     than half of survey respondents (55%) said they are not very familiar with
     the use of AI and machine learning in healthcare, and only a quarter of                97%
     respondents believe AI will have a significant impact on rheumatology                  40%
     care over the next three years. In addition, less than one third (32%)
     say they can envision AI playing an important role in informing their                 Inventory management system
     treatment decisions in the future. These results are somewhat surprising
     when considering the growing body of research showing the application                  13%
     of AI to evaluate rheumatologic disease and to predict how it will progress.
                                                                                            10%
     In addition, when asked about future applications of AI and machine
     learning, less than half (45%) say it is likely or very likely that they will drive   Practice management system
     operational efficiencies for rheumatology practices, and far fewer say it is
     likely that AI and machine learning will help to improve the quality of care           25%
     (36%) or lower healthcare costs (27%).                                                 24%
     Interestingly, many of the challenges facing rheumatologists today may
     eventually be addressed by AI-powered solutions. As our survey shows,                 Infusion management tool
     rheumatologists continue to cite declining reimbursement as their
     top challenge, and AI is increasingly being used within revenue cycle                  17%
     management tools to increase efficiency and make financial management                  19%
     more predictable. We are also seeing a growing use of AI in population
     health tools, which can be used to guide clinical decisions, such as which            Analytics and reporting tools
     patients are likely to be adherent to their treatment plan or to experience
     clinical deterioration. These tools may help providers to identify patients            25%                                                                        Solutions in place
     that need proactive interventions or additional supportive services.
                                                                                            24%                                                                  Likely to invest in coming year
     Overall, our survey suggests there is a need for more education around
     the role that technology can play in supporting rheumatologists. Those                                                                             N = 87
     providers who embrace the opportunities early may see advantages in
     both clinical care delivery and the financial performance of their practice.

                                                                                                                       About 40% of participating rheumatologists
                                                                                                                       plan to invest in EHRs in the coming year though nearly all
                                                                                                                       have a system in place.

24                                                                                                                                                                                                  25
AI / MACHINE LEARNING

                                                      NEAR-TERM OUTLOOK ON AI: Most rheumatologists surveyed
                                                      said they have limited familiarity with artificial intelligence (AI)/
                                                      machine learning in healthcare and see minimal impact over the
                                                      next three years.
                                                      How familiar are you with the use of AI/machine learning in healthcare?

                                                               10          %
                                                                 Very familiar
                                                                                                    33            %
                                                                                                    Moderately familiar
                                                                                                                                           56            %
                                                                                                                                            Not very familiar

                                                      N = 87

                                                      What impact do you expect AI/machine learning to have on rheumatology care over the
                                                      next three years?

                                                                53%                                    24%                                    23%
     Over 75% of rheumatologists surveyed predicted   Limited impact. We may see some       Significant impact. A considerable       No impact. The promise of AI is
                                                                                                                                     mostly theoretical at this point.
     limited or no impact of AI and machine            adoption of AI tools among select
                                                           rheumatology practices.
                                                                                           number of practices are likely to adopt
                                                                                             AI tools over the next three years.
     learning on care in the next three years.
                                                      N = 87

26                                                                                                                                                                       27
AI / MACHINE LEARNING

        THE LONGER VIEW: Looking longer-term, participating
        rheumatologists are generally pessimistic about the potential
        of AI/machine learning, with less than half believing it is likely
        or very likely to improve quality of care, drive operational
        efficiencies, enhance clinical outcomes or lower costs.

        Improve quality of care             Drive operational efficiencies

         8%                                  15%
        Very likely                         Very likely

         25%                                 26%
        Likely                              Likely

         40%                                 43%
        Somewhat likely                     Somewhat likely

         21%                                 12%
        Unlikely                            Unlikely

         6%                                  5%
        Very unlikely                       Very unlikely

        Enhance clinical outcomes           Lower costs

         13%                                 10%
        Very likely                         Very likely

         21%                                 15%
        Likely                              Likely

         40%                                 36%
        Somewhat likely                     Somewhat likely

         20%                                 32%
        Unlikely                            Unlikely

         7%                                  7%
        Very unlikely                       Very unlikely

        N = 87

28                                                                           29
AI / MACHINE LEARNING

      POTENTIAL AI BENEFITS: Only one-third of participating
      rheumatologists can envision AI playing an important role
      in treatment decisions, but 46% say it could provide value in
      automating administrative tasks.

      When it comes to using AI/machine learning to support treatment decisions, which of
      the following best reflects your view?

                  64%                                       26%                                        9%
        AI tools may provide some useful         I can envision AI playing an important   I would not use an AI tool to support
     information, but ultimately, I would rely       role in informing my treatment             my treatment decisions
      on my own training and judgment to           decisions, particularly as treatment
            guide treatment decisions                 options grow more complex

      N = 87

      Which of the following would be the most valuable benefit that AI/machine learning
      could deliver to your practice?
      Automating administrative tasks
      so I can focus on patients                                                                                       46%
      Identifying best treatment path so patients
      get the right drug the first time                                                                                 18%
      Predicting patients most likely to develop
      complications or experience adverse events                                                                        13%
      Accelerating diagnosis so patients
      can start treatment sooner                                                                                        12%
      Automating functions that are currently staffed
      by people, allowing my practice to save money                                                                       9%
      Predicting patients most likely to be
      non-adherent to therapy                                                                                             2%

      N = 87

30                                                                                                                                31
Contributors                                                                                  References
Gordon K. Lam, MD, FACR                                                                       1    https://acrabstracts.org/abstract/lasting-covid-19-impacts-on-us-rheumatology-
                                                                                                   practices/
Medical Director, Clinical and Translational Research
Arthritis & Osteoporosis Consultants of the Carolinas                                         2    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057822/

                                                                                              3    https://www.cms.gov/files/document/mm12244.pdf
Amy Valley, PharmD
Vice President, Clinical Strategy and Technology Solutions                                    4    https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-warnings-
                                                                                                   about-increased-risk-serious-heart-related-events-cancer-blood-clots-and-death
Cardinal Health Specialty Solutions
                                                                                              5    https://www.cnn.com/2021/08/27/health/actemra-shortage-rheumatoid-
                                                                                                   arthritis-covid/index.html

A note from our medical team                                                                  6    https://acrabstracts.org/abstract/an-artificial-intelligence-ai-assistant-
                                                                                                   identifying-spinal-diffuse-idiopathic-skeletal-hyperostosis-on-plain-x-rays-a-
Duis aliquam tellus elementum tortor cursus, quis dictum                                           pilot-deep-learning-study/
ipsum efficitur. Aliquam elementum ultricies semper. Nulla                                    7    https://acrabstracts.org/abstract/identification-of-a-rule-to-predict-response-to-
semper mattis elit, sed imperdiet lectus dictum eu. In ut magna                                    sarilumab-in-patients-with-rheumatoid-arthritis-using-machine-learning-and-
in est condimentum condimentum. Vestibulum lacinia gravida                                         clinical-trial-data/

sapien eu vestibulum. Mauris id bibendum purus. Donec                                         8    https://acrabstracts.org/abstract/development-and-preliminary-validation-of-
sollicitudin euismod mollis.                                                                       smartphone-sensor-based-measurement-tools-for-psoriatic-arthritis/

                                                                                              9    https://ard.bmj.com/content/early/2021/08/22/annrheumdis-2021-220597

                                                                                              10   https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/1159
Methodology                                                                                   11   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124803/#:~:text=The%20
The research was fielded using web-based surveys in July                                           survey%20revealed%20that%2064,no%20preference%20(Table%202).

through September 2021. Nearly 90 rheumatologists from a                                      12   https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-warnings-
mix of community- and hospital-based practices participated                                        about-increased-risk-serious-heart-related-events-cancer-blood-clots-and-death

in the research.                                                                              13   https://www.cnn.com/2021/08/27/health/actemra-shortage-rheumatoid-
                                                                                                   arthritis-covid/index.html

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