title: Value of primary care diabetes management: long-term cost impacts.
abstract: OBJECTIVE
  To estimate long-term cost savings associated with patients' exposure to an all-or-none bundle of measures for primary care management of diabetes.
  
  
  METHODS
  In 2006, Geisinger's primary care clinics implemented an all-or-none diabetes system of care (DSC). Claims data from Geisinger Health Plan were used to identify those who met Healthcare Effectiveness Data and Information Set criteria for diabetes and had 2 or more diabetes-related encounters on different dates before 2006. A cohort of 1875 members exposed to the DSC was then compared against a propensity score matched non-DSC comparison cohort from January 1, 2006, through December 31, 2013.
  
  
  METHODS
  A set of generalized linear models with log link and gamma distribution was estimated. The key explanatory variable was each member's bundle exposure measured in months. The dependent variables were inpatient and outpatient facility costs, professional cost, and total medical cost excluding prescription drugs measured on a per-member-per-month basis.
  
  
  RESULTS
  Over the study period, the total medical cost saving associated with DSC exposure was approximately 6.9% (P < .05). The main source of the saving was reductions in inpatient facility cost, which showed approximately 28.7% savings (P < .01) over the study period. During the first year of the DSC exposure, however, there were significant increases in outpatient (13%; P < .05) and professional (9.7%; P < .05) costs.
  
  
  CONCLUSIONS
  A system of care with an all-or-none bundled measure used in primary care for patients with diabetes may reduce long-term cost of care while improving health outcomes.
authors.affiliation: Geisinger Center for Health Research, 100 N Academy Ave, MC 44-00, Danville, PA 17822. E-mail: ddmaeng@geisinger.edu.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Maeng
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Yan
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Graf
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Steele
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics; D017046:Cost Savings; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D016014:Linear Models; D008134:Long-Term Care / Q000191:economics; D008297:Male; D011320:Primary Health Care / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies; D014481:United States