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

Abstract

Objective: To determine if 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: 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 a multi-site rural Federally Qualified Community Health Center (FQHC) located in South Carolina. Control patients were matched to team care patients utilizing propensity score techniques. Financial outcomes compared Medicaid (and Medicare for dual eligible patients) payments one year pre- and post-intervention. Trends over time in levels of HbA_1c, Body Mass Index (BMI), and systolic blood pressure (SBP) were analyzed for intervention patients during the post-intervention period.

Results: While average claims payments increased for both the CareSouth patients and controls there were no statistically significant differences in total payments between the two groups. In the intervention group, patients with HbA_1c > 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 fell an average 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.