Despite advances in the scientific knowledge related to diabetes prevention and management, diabetes prevalence, complications, and costs continues to rise. A majority of the dollars that go towards diabetes care are spent on Emergency Department visits, hospitalizations, and the management of diabetes complications. Changing the trajectory of the diabetes epidemic in the United States may require a fundamentally new approach to chronic disease management and reimbursement that emphasizes disease prevention and management. Accountable Care Organizations (ACOs) could be such an approach. Under this model, an organization is charged with the care of a population, receives a capitated payment and may be eligible for either a share of any savings achieved and/or at risk for a portion of any spending over the set target. As such, ACOs have been proposed as a means to simultaneously improve population health and reduce health care costs. The Alabama Medicaid program is undergoing a major transformation from a traditional fee for service model to the establishment of ACOs (referred to in Alabama as RCOs or Regional Care Organizations). The Alabama Care Plan, one of 6 probationary RCOs, will assume care for over 70,000 Medicaid recipients in Region B, 11% of whom have diabetes. In April 2015, VIVA Health, a local managed care organization and the lead entity in the Alabama Care Plan, began creating care coordination teams that will work with individuals' current health care providers to comprise a larger health home. This phased transition provides a unique opportunity for us to assess the impact of policy change related to reimbursement and the delivery of health care as it relates to diabetes. With this proposal, investigators will conduct a rigorous evaluation of the impact of this transition on outcomes in three dimensions: health of a population, experience of care, and per capita cost.
The specific aims are: 1. To examine changes in diabetes related population health measures, including glycemic control (HbA1c) and indicators of diabetes care (quarterly HbA1c, annual eye exam); 2. To examine patient experience of care using a telephone-administered survey and qualitative interviews with a subset of individuals with type 2 diabetes enrolled in the Health Home; and 3.To examine changes in health care utilization and overall cost effectiveness of the newly implemented RCO and Health Home compared to diabetes care before RCO implementation. Using Medicaid data beginning in 2010 through 2019, investigators will conduct interrupted time series analyses of data from enrollees within Region B and difference-in- differences analyses to compare changes over time in Region B with changes over time in 3 southern, non- ACO states. The multidisciplinary team of investigators has expertise in diabetes research, use of CMS data, survey administration and qualitative methods. Alabama has the highest rate of diabetes in the United States. As such, this study could have important local and national policy implications for new approaches to diabetes management.
Despite advances in the scientific knowledge related to diabetes prevention and management, diabetes prevalence, complications, and costs continues to rise. Accountable care organizations (ACOs) have been proposed as a means to simultaneously improve population health and reduce health care costs. This study will provide a rigorous evaluation of the Alabama Medicaid Program's transition from a fee-for-service model to a risk-sharing ACO model on diabetes outcomes.
| Shelley, John; Kilgore, Meredith; Cherrington, Andrea (2017) Reducing Disparities In Access To Health Care. Health Aff (Millwood) 36:2211 |
