Trends in Costs of Care and Utilization for Medicaid Patients With Diabetes in Accountable Care Communities.

Autor:	Moin T; David Geffen School of Medicine at UCLA.; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health System., Harwood JM; David Geffen School of Medicine at UCLA., Mangione CM; David Geffen School of Medicine at UCLA.; Jonathan and Karin Fielding School of Public Health at UCLA, Los Angeles, CA., Jackson N; David Geffen School of Medicine at UCLA., Ho S; UnitedHealthcare, Minnetonka, MN., Ettner SL; David Geffen School of Medicine at UCLA.; Jonathan and Karin Fielding School of Public Health at UCLA, Los Angeles, CA., Duru OK; David Geffen School of Medicine at UCLA.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2020 Jun; Vol. 58 Suppl 6 Suppl 1, pp. S40-S45.
DOI:	10.1097/MLR.0000000000001318
Abstrakt:	Background/objectives: Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by UnitedHealthcare to improve care for Medicaid beneficiaries. We examined changes in costs and utilization for Medicaid beneficiaries with diabetes assigned to ACC versus usual care practices. Research Design: Interrupted time series with concurrent control group analysis, at the person-month level. The ACC was implemented in 14 states, and we selected comparison non-ACC practices from those states to control for state-level variation in Medicaid program. We adjusted the models for age, sex, race/ethnicity, comorbidities, seasonality, and state-by-year fixed effects. We examined the difference between ACC and non-ACC practices in changes in the time trends of expenditures and hospital and emergency room utilization, for the 4 largest categories of Medicaid eligibility [Temporary Assistance to Needy Families, Supplemental Security Income (without Medicare), Expansion, Dual-Eligible]. Subjects/measures: Eligibility and claims data from Medicaid adults with diabetes from 14 states between 2010 and 2016, before and after ACC implementation. Results: Analyses included 1,200,460 person-months from 66,450 Medicaid patients with diabetes. ACC implementation was not associated with significant changes in outcome time trends, relative to comparators, for all Medicaid categories. Conclusions: Medicaid patients assigned to ACC practices had no changes in cost or utilization over 3 years of follow-up, compared with patients assigned to non-ACC practices. The ACC program may not reduce costs or utilization for Medicaid patients with diabetes.
Databáze:	MEDLINE
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