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Financial and clinical impact of team-based treatment for medicaid enrollees with diabetes in a federally qualified health center.

Scanlon DP, Hollenbeak CS, Beich J, Dyer AM, Gabbay RA, Milstein A - Diabetes Care (2008)

Bottom Line: Financial outcomes compared Medicaid (and Medicare for dually eligible patients) payments 1 year before and after intervention.Although average claims payments increased for both the CareSouth patients and control patients, there were no statistically significant differences in total payments between the two groups.In the intervention group, patients with A1C >9 at baseline experienced an average reduction of 0.75 mg/dl per year (95% CI 0.50-0.99), patients with BMI >30 at baseline had an average reduction of 2.3 points per year (95% CI 0.99-3.58), and patients with SBP >140 mmHg at baseline had an average reduction of 2.2 mmHg per year (95% CI 0.44-3.88).

View Article: PubMed Central - PubMed

Affiliation: Penn State University, University Park, Pennsylvania, USA. dpscanlon@psu.edu

ABSTRACT

Objective: The purpose of this study was to determine whether multidisciplinary team-based care guided by the chronic care model can reduce medical payments and improve quality for Medicaid enrollees with diabetes.

Research design and methods: This study was a difference-in-differences analysis comparing Medicaid patients with diabetes who received team-based care versus those who did not. Team-based care was provided to patients treated at CareSouth, a multisite rural federally qualified community health center located in South Carolina. Control patients were matched to team care patients using propensity score techniques. Financial outcomes compared Medicaid (and Medicare for dually eligible patients) payments 1 year before and after intervention. Trends over time in levels of A1C, BMI, and systolic blood pressure (SBP) were analyzed for intervention patients during the postintervention period.

Results: Although average claims payments increased for both the CareSouth patients and control patients, there were no statistically significant differences in total payments between the two groups. In the intervention group, patients with A1C >9 at baseline experienced an average reduction of 0.75 mg/dl per year (95% CI 0.50-0.99), patients with BMI >30 at baseline had an average reduction of 2.3 points per year (95% CI 0.99-3.58), and patients with SBP >140 mmHg at baseline had an average reduction of 2.2 mmHg per year (95% CI 0.44-3.88).

Conclusions: Team-based care following the chronic care model has the potential to improve quality without increasing payments. Short-term savings were not evident and should not be assumed when designing programs.

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Related in: MedlinePlus

Differences between CareSouth patients and control subjects in changes of annual payments from the year before the interventions to the year after. The black boxes represent the point estimates of the difference in differences, and the lines represent the CIs of the parameters.
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f1: Differences between CareSouth patients and control subjects in changes of annual payments from the year before the interventions to the year after. The black boxes represent the point estimates of the difference in differences, and the lines represent the CIs of the parameters.

Mentions: Our analysis showed that average 1-year payments at baseline were significantly lower for CareSouth patients for nonhospital-based outpatient care ($2,096.60 vs. $2,940.80, P = 0.025) and significantly higher for hospital-based outpatient care ($445.70 vs. $260.50, P = 0.012) (Table 1). Differences in other subcategories of payments were not statistically significant, either at baseline or after the intervention (Table 1). For CareSouth patients, average 1-year payments before and after the intervention rose in the postintervention period for all types of care except hospital-based outpatient care; for control patients, these payments rose for all types of care except inpatient care (Table 1). Figure 1 presents the estimates and CIs of the parameters in the difference-in-differences regressions. None of the differences noted were statistically significant except for hospital-based outpatient payments, which was significantly lower for the CareSouth group. However, the apparent advantage of team care in this category resulted from differences in preintervention rather than postintervention costs.


Financial and clinical impact of team-based treatment for medicaid enrollees with diabetes in a federally qualified health center.

Scanlon DP, Hollenbeak CS, Beich J, Dyer AM, Gabbay RA, Milstein A - Diabetes Care (2008)

Differences between CareSouth patients and control subjects in changes of annual payments from the year before the interventions to the year after. The black boxes represent the point estimates of the difference in differences, and the lines represent the CIs of the parameters.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571067&req=5

f1: Differences between CareSouth patients and control subjects in changes of annual payments from the year before the interventions to the year after. The black boxes represent the point estimates of the difference in differences, and the lines represent the CIs of the parameters.
Mentions: Our analysis showed that average 1-year payments at baseline were significantly lower for CareSouth patients for nonhospital-based outpatient care ($2,096.60 vs. $2,940.80, P = 0.025) and significantly higher for hospital-based outpatient care ($445.70 vs. $260.50, P = 0.012) (Table 1). Differences in other subcategories of payments were not statistically significant, either at baseline or after the intervention (Table 1). For CareSouth patients, average 1-year payments before and after the intervention rose in the postintervention period for all types of care except hospital-based outpatient care; for control patients, these payments rose for all types of care except inpatient care (Table 1). Figure 1 presents the estimates and CIs of the parameters in the difference-in-differences regressions. None of the differences noted were statistically significant except for hospital-based outpatient payments, which was significantly lower for the CareSouth group. However, the apparent advantage of team care in this category resulted from differences in preintervention rather than postintervention costs.

Bottom Line: Financial outcomes compared Medicaid (and Medicare for dually eligible patients) payments 1 year before and after intervention.Although average claims payments increased for both the CareSouth patients and control patients, there were no statistically significant differences in total payments between the two groups.In the intervention group, patients with A1C >9 at baseline experienced an average reduction of 0.75 mg/dl per year (95% CI 0.50-0.99), patients with BMI >30 at baseline had an average reduction of 2.3 points per year (95% CI 0.99-3.58), and patients with SBP >140 mmHg at baseline had an average reduction of 2.2 mmHg per year (95% CI 0.44-3.88).

View Article: PubMed Central - PubMed

Affiliation: Penn State University, University Park, Pennsylvania, USA. dpscanlon@psu.edu

ABSTRACT

Objective: The purpose of this study was to determine whether multidisciplinary team-based care guided by the chronic care model can reduce medical payments and improve quality for Medicaid enrollees with diabetes.

Research design and methods: This study was a difference-in-differences analysis comparing Medicaid patients with diabetes who received team-based care versus those who did not. Team-based care was provided to patients treated at CareSouth, a multisite rural federally qualified community health center located in South Carolina. Control patients were matched to team care patients using propensity score techniques. Financial outcomes compared Medicaid (and Medicare for dually eligible patients) payments 1 year before and after intervention. Trends over time in levels of A1C, BMI, and systolic blood pressure (SBP) were analyzed for intervention patients during the postintervention period.

Results: Although average claims payments increased for both the CareSouth patients and control patients, there were no statistically significant differences in total payments between the two groups. In the intervention group, patients with A1C >9 at baseline experienced an average reduction of 0.75 mg/dl per year (95% CI 0.50-0.99), patients with BMI >30 at baseline had an average reduction of 2.3 points per year (95% CI 0.99-3.58), and patients with SBP >140 mmHg at baseline had an average reduction of 2.2 mmHg per year (95% CI 0.44-3.88).

Conclusions: Team-based care following the chronic care model has the potential to improve quality without increasing payments. Short-term savings were not evident and should not be assumed when designing programs.

Show MeSH
Related in: MedlinePlus