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.


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.
Scanlon
Dennis P
DP
Penn State University, University Park, Pennsylvania, USA. dpscanlon@psu.edu
Hollenbeak
Christopher S
CS
Beich
Jeff
J
Dyer
Anne-Marie
AM
Gabbay
Robert A
RA
Milstein
Arnold
A
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