Abstract
Historic changes in healthcare reimbursement and payment models due to the Affordable Care Act in the United States have the potential to transform how providers care for chronic diseases such as diabetes. Payment experimentation has provided insights into how changing incentives for primary care providers can yield improvements in the triple aim: improving patient experience, improving the health of populations, and reducing costs of healthcare. Much of this has involved leveraging widespread adoption of the patient-centered medical home (PCMH) with diabetes often the focus. While evidence is mounting that the PCMH can improve diabetes outcomes, some PCMH demonstrations have displayed mixed results. One of the first large-scale PCMH demonstrations developed around diabetes was conducted by the Commonwealth of Pennsylvania. Different payment models were employed across a series of staggered regional rollouts that provided a case study for the influence of innovative payment models. These learning laboratories provide insights into the role of reimbursement models and changes in how practice transformation is implemented. Ultimately, evolving payment systems focused on the total cost of care, such as Accountable Care Organizations, hold promise to transform diabetes care and produce significant cost savings through the prevention of complications.
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References
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Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.
Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation.
Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metrics. 2010;8:29.
American Diabetes Assocation. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–46. doi:10.2337/dc12-2625.
U.S. Department of Health and Human Services. Better, smarter, healthier: in historic announcement, HHS sets clear goal and timeline for shifting Medicare reimbursements from volume to value. Retrieved from: http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html. Accessed 16 Nov 2015.
Berwick DM, Nolan TW, Whittington J. The triple aim: care health, and cost. Health Aff. 2008;27(3):759–69.
Berwick DM. Launching accountable care organization—the proposed rule for the Medicare Shared Savings Program. N Engl J Med. 2011;364(16), e32.
Patient-centered medical home resource center. Defining the PCMH. Agency for Healthcare Research and Quality. Retrieved on November 15, 2015.
Bailit M. Payment Rate Brief. Patient-centered primary care collaborative. March 2011. Accessed at: https://www.pcpcc.org/sites/default/files/media/payment_brief_2011.pdf
Gabbay RA, Bailit MH, Mauger DT, Wagner EH, Siminerio L. Multipayer patient-centered medical home implementation guided by the chronic care model. Jt Comm J Qual Patient Saf. 2011;37(6):265–73. This study describes the Pennsylvania Chronic Care Initiative Program and presents the first year intervention results from the first regional roll out on quality and PCMH recognition.
Pennsylvania Chronic Care Initiative (CCI). Patient-centered primary care collaborative. https://www.pcpcc.org/initiative/pennsylvania-chronic-care-initiative-cci. Accessed 15 Nov 2015.
Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311(8):815–25.
Gabbay RA, Friedberg MW, Miller-Day M, Cronholm PF, Adelman A, Schneider EC. A positive deviance approach to understanding key features to improving diabetes care in the medical home. Ann Fam Med. 2013;11 suppl 1:S99–107. This study assessed the capabilities of primary care practices transforming into PCMHs and their infrastructure developed for managing a chronic disease, such as diabetes. Findings demonstrated baseline key structural capabilities and abilities are a measure of success to transform primary care practices.
Higgins S, Chawla R, Colombo C, Snyder R, Nigam S. Medical homes and cost utilization among high risk patients. AJMC. 2014;20(3):e61–71.
Friedberg MW, Rosenthal MB, Werner RM, Volpp KG, Schneider EC. Effects of a medical home and shared savings intervention on quality and utilization of care. JAMA Intern Med. 2015;175(8):1362–8. This study assessed the outcomes of a statewide, multi-payer Pennsylvania Chronic Care Initiative in the last of the regional rollouts to transform practices into PCMHs. The RAND analysis demonstrates improvement in quality, increased primary care utilization, and lower use of emergency department, hospital, and specialty care incentivized through a shared savings program.
Martsolf GR, Kandrac R, Gabbay RA, Friedberg MW. Cost of transformation among primary care practices participating in a medical home pilot. J Gen Intern Med. 2015. doi:10.1007/s11606-015-3553-6.
Spatz C, Gabbay R. The patient-centered medical neighborhood and diabetes care. Diabetes Spectr. 2014;27(2):131–3.
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Erin L. McGinley and Robert A. Gabbay declare that they have no conflict of interest.
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This article is part of the Topical Collection on Economics and Policy in Diabetes
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McGinley, E.L., Gabbay, R.A. The Impact of New Payment Models on Quality of Diabetes Care and Outcomes. Curr Diab Rep 16, 51 (2016). https://doi.org/10.1007/s11892-016-0743-5
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DOI: https://doi.org/10.1007/s11892-016-0743-5