title: Financial and clinical impact of team-based treatment for medicaid enrollees with diabetes in a federally qualified health center.
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.
  
  
  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.
authors.affiliation: Penn State University, University Park, Pennsylvania, USA. dpscanlon@psu.edu
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Scanlon
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Jeff
authors.initials: J
authors.lastname: Beich
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dyer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gabbay
authors.forename: Arnold
authors.initials: A
authors.lastname: Milstein
mesh_terms: D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007345:Insurance Claim Review; D008484:Medicaid / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics; D017749:Total Quality Management / Q000191:economics; D014481:United States