Jeff Beich

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

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.

The role of disease management in pay-for-performance programs for improving the care of chronically ill patients.

To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health’s eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association betweenRFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

Building The Scaffold To Improve Health Care Quality In Western New York

Many health policy leaders are promoting the community as a place to try out new ideas for improving the quality of health care. Alliances with multiple stakeholders are moving forward with communitywide efforts to improve the quality of care without the benefit of an established evidence base or guiding framework. This article presents a profile of one communitys attempt to facilitate and coordinate quality improvement in its geographic area. The P(2) Collaborative of Western New York is one of sixteen sites supported by the Robert Wood Johnson Foundations national Aligning Forces for Quality initiative. The strategy and vision of the collaborative has evolved as it has tried to capitalize on opportunities and overcome barriers in its work. The article concludes with a discussion of eight tasks that community alliances may consider undertaking when establishing an infrastructure for improving the quality of health care, such as convening area stakeholders to develop a strategy and finding ways to monitor health outcomes at the local level on an ongoing basis.