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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

Summary of trends in clinical measures among CareSouth patients, adjusted for demographics, comorbidities, and patient level clustering. *P <0.05; **P <0.01; ***P <0.0001. Patients with two, three, or four (or more) observations of BMI were 28, 12, and 27, respectively. Comparable numbers for A1C were 35, 28, and 108 and for SPB 11, 15, and 167.
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f2: Summary of trends in clinical measures among CareSouth patients, adjusted for demographics, comorbidities, and patient level clustering. *P <0.05; **P <0.01; ***P <0.0001. Patients with two, three, or four (or more) observations of BMI were 28, 12, and 27, respectively. Comparable numbers for A1C were 35, 28, and 108 and for SPB 11, 15, and 167.

Mentions: Results in Fig. 2 suggest that among all CareSouth patients, A1C did not change significantly over time, but among patients with a baseline A1C >9 mg/dl, A1C decreased significantly over time. For this subset, the average ± SD baseline A1C was 9.75 ± 2.25 mg/dl and fell ∼0.75 mg/dl per year (P < 0.0001). CareSouth patients had a starting BMI of 35.0 ± 10.4 kg/m2 and experienced an average decrease of 1.9 points per year (P < 0.0001). Among CareSouth patients with a starting BMI >30 kg/m2 (40.1 ± 9.5), BMI fell ∼2.3 points per year (P = 0.001). Similarly, among all CareSouth patients, SBP decreased significantly over time (−0.88 mmHg per year, P = 0.014) and patients with a baseline SBP >140 mmHg also had a significant drop in blood pressure over time (−2.2 mmHg per year, P = 0.035).


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)

Summary of trends in clinical measures among CareSouth patients, adjusted for demographics, comorbidities, and patient level clustering. *P <0.05; **P <0.01; ***P <0.0001. Patients with two, three, or four (or more) observations of BMI were 28, 12, and 27, respectively. Comparable numbers for A1C were 35, 28, and 108 and for SPB 11, 15, and 167.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2: Summary of trends in clinical measures among CareSouth patients, adjusted for demographics, comorbidities, and patient level clustering. *P <0.05; **P <0.01; ***P <0.0001. Patients with two, three, or four (or more) observations of BMI were 28, 12, and 27, respectively. Comparable numbers for A1C were 35, 28, and 108 and for SPB 11, 15, and 167.
Mentions: Results in Fig. 2 suggest that among all CareSouth patients, A1C did not change significantly over time, but among patients with a baseline A1C >9 mg/dl, A1C decreased significantly over time. For this subset, the average ± SD baseline A1C was 9.75 ± 2.25 mg/dl and fell ∼0.75 mg/dl per year (P < 0.0001). CareSouth patients had a starting BMI of 35.0 ± 10.4 kg/m2 and experienced an average decrease of 1.9 points per year (P < 0.0001). Among CareSouth patients with a starting BMI >30 kg/m2 (40.1 ± 9.5), BMI fell ∼2.3 points per year (P = 0.001). Similarly, among all CareSouth patients, SBP decreased significantly over time (−0.88 mmHg per year, P = 0.014) and patients with a baseline SBP >140 mmHg also had a significant drop in blood pressure over time (−2.2 mmHg per year, P = 0.035).

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