The Alabama Care Plan: Assessing the Impact of Regional Care Organizations on Diabetes Outcomes in a Sample of Alabama Medicaid Recipients

阿拉巴马州护理计划：评估区域护理组织对阿拉巴马州医疗补助接受者样本中糖尿病结果的影响

• 批准号: 9102469
• 负责人: Andrea L Cherrington
• 金额: $ 47.75万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9102469
• 关键词: Accident and Emergency department; Acute; Address; Alabama; Behavior Therapy; Benchmarking; Blindness; Cardiovascular system; Caring; Charge; Chronic; Chronic Disease; Cities; Community Health; Complications of Diabetes Mellitus; Country; Data; Data Analyses; Diabetes Mellitus; Diabetes prevention; Diagnosis; Dimensions; Disease Management; Effectiveness; Emergency department visit; Enrollment; Epidemic; Evaluation; Event; Fee-for-Service Plans; Glycosylated hemoglobin A; Guidelines; Health; Health Care Costs; Health Personnel; Health system; Healthcare; Home environment; Hospitalization; Impact evaluation; Individual; Institutes; Interview; Kidney Failure; Knowledge; Lead; Lower Extremity; Managed Care; Measures; Medicaid; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Ophthalmic examination and evaluation; Outcome; Patients; Pharmacists; Phase Transition; Policies; Population; Preparation; Prevalence; Prevention; Primary Care Physician; Primary Health Care; Qualifying; Qualitative Methods; Research; Research Personnel; Risk; Sampling; Savings; Self Care; Self Management; Series; Services; Social Workers; Structure; Surveys; Team Nursing; Telephone; Time; United States; United States Centers for Medicare and Medicaid Services; Work; base; beneficiary; capitate bone; cost; cost effectiveness; diabetes management; disorder prevention; experience; glycemic control; health care delivery; health care service utilization; improved; limb amputation; mortality; multidisciplinary; novel strategies; payment; policy implication; population health; programs; public health relevance; risk sharing; satisfaction; secondary outcome; stem

 DESCRIPTION (provided by applicant):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.

 描述（由适用提供）：尽管与糖尿病预防和管理有关的科学知识取得了进步，但糖尿病患病率，并发症和成本仍在继续上升。用于糖尿病护理的大部分钱用于急诊就诊，住院和糖尿病并发症的管理。改变美国糖尿病流行的轨迹可能需要一种从根本上进行慢性病管理和报销的新方法，以强调预防疾病和管理。负责任的护理组织（ACO）可能是一种方法。在此模型下，组织被控以照顾人口，获得了大写的付款，并且可能有资格获得所获得的任何储蓄的一部分和/或面临于设定目标上任何支出的一部分风险。因此，已经提出了ACO作为简单改善人口健康并降低医疗保健成本的一种手段。阿拉巴马州医疗补助计划正在从传统的服务模型费用到建立ACO（在阿拉巴马州称为RCOS或区域护理组织）的重大转变。阿拉巴马州的6个试用RCO之一，将为B地区的70,000多名医疗补助接受者提供护理，其中11％患有糖尿病。 2015年4月，当地托管护理组织和阿拉巴马州护理计划的主要实体Viva Health开始创建护理协调团队，该团队将与个人当前的医疗保健提供者合作，以组成更大的“健康之家”。这种分阶段的过渡为我们提供了一个独特的机会，可以评估与报销相关的政策变更影响以及与糖尿病有关的医疗保健的影响。通过此提案，调查人员将进行 严格评估这种过渡对三个维度结果的影响：人口的健康，护理经验和人均成本。具体目的是：1。检查糖尿病相关人群健康指标的变化，包括血糖控制（HBA1C）和糖尿病护理指标（季度HBA1C，年度眼科检查）； 2。使用电话管理的调查和与卫生所住房中2型糖尿病的一个人的一部分进行定性访谈来检查患者的护理经验； 3.与RCO实施前相比，与糖尿病护理相比，新实施的RCO和健康之家的医疗保健利用率和总体成本效益的变化。使用从2010年到2019年开始的医疗补助数据，研究人员将对B区域内注册的数据进行中断的时间序列分析，并进行差异分析，以比较B区域B的变化与3个南部，非ACO状态的随时间变化。研究人员的多学科团队拥有糖尿病研究，使用CMS数据，调查管理和定性方法的专家。阿拉巴马州的糖尿病发生率最高。因此，这项研究可能对糖尿病管理的新方法具有重要的本地和国家政策影响。