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（由申请人提供）：尽管与糖尿病预防和管理相关的科学知识不断进步，但糖尿病患病率、并发症和费用仍在持续上升，用于糖尿病护理的大部分资金都花在了急诊科就诊、住院治疗、改变美国糖尿病流行的轨迹可能需要一种强调疾病预防和管理的全新方法。这模型中，一个组织负责照顾人口，接受按人头付费，并且可能有资格获得所实现的任何节省的一部分和/或面临超过设定目标的任何支出的一部分的风险。阿拉巴马州医疗补助计划正在经历从传统收费服务模式到建立 ACO（阿拉巴马州称为 RCO 或区域护理组织）的重大转变。阿拉巴马州护理计划，6 个计划之一试用 RCO 将承担 B 区 70,000 多名医疗补助受益人的护理工作，其中 11% 患有糖尿病。 2015 年 4 月，当地管理式护理组织和阿拉巴马州护理计划的牵头实体 VIVA Health 开始创建护理协调团队。将与个人当前的医疗保健提供者合作，组成一个更大的“健康之家”。这一分阶段过渡为我们提供了一个独特的机会，以评估与糖尿病相关的报销和医疗保健提供相关的政策变化的影响。根据这项提议，调查人员将进行 严格评估这一转变对人口健康、护理体验和人均成本三个维度的影响 具体目标是： 1. 检查糖尿病相关人口健康指标的变化，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. 通过电话调查和对参加健康之家的 2 型糖尿病患者进行定性访谈来检查患者的护理体验；到与实施 RCO 之前的糖尿病护理相比，研究新实施的 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 2010 年至 2019 年的医疗补助数据，研究人员将对 B 区和差异中的差异分析将 B 区随时间的变化与阿拉巴马州南部 3 个州随时间的变化进行比较。多学科研究团队在糖尿病研究、CMS 数据的使用、调查管理和定性方法方面拥有专业知识。具有最高的因此，这项研究可能对糖尿病管理的新方法产生重要的地方和国家政策影响。