Financial and Clinical Impact of Team-Based Treatment for Medicaid Enrollees With Diabetes in a Federally Qualified Health Center

  1. Dennis P. Scanlon, PHD1,
  2. Christopher S. Hollenbeak, PHD2,
  3. Jeff Beich, PHD1,
  4. Anne-Marie Dyer, MA2,
  5. Robert A. Gabbay, MD, PHD2 and
  6. Arnold Milstein, MD3
  1. 1Penn State University, University Park, Pennsylvania
  2. 2Penn State College of Medicine, Hershey, Pennsylvania
  3. 3Pacific Business Group on Health and Mercer Health and Benefits, San Francisco, California
  1. Corresponding author: Dennis P. Scanlon, dpscanlon{at}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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 4 August 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted July 25, 2008.
    • Received March 21, 2008.
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  1. Diabetes Care vol. 31 no. 11 2160-2165
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