172-OR: Diabetes Care Management (DCM) Under Total Cost of Care (TCOC) Budgeting: Insights from a Medicaid Cohort

Abstract

Background: DCM interventions improve glycemic control and readmission. Cost effectiveness studies typically use only system EHR data. We implemented a 3-month technology-enabled DCM intervention (Diabetes Boot Camp (DBC)) for adults with uncontrolled T2DM in a regional health system. Using EHR data, DBC was shown to reduce A1C and hospitalizations compared to matched controls. The aim of this study was a TCOC assessment of DBC among Medicaid participants using claims data. Methods: Medicaid-enrolled DBC completers and controls were linked to Maryland’s Medicaid Management Information System. The impact of DBC on different components of spending and TCOC at 90 days was evaluated. Results: Among the 47 cases and 60 controls, average age was 52; 72.9% were Black; and 67.3% were female. DBC was associated with a per person reduction of $197 in ED/inpatient spending but an increase of $1,471 in TCOC, driven primarily by greater pharmacy spending and outpatient visits. Increased pharmacy spending was driven by spending on insulins and newer medication classes (Table 1). Conclusions: In a TCOC analysis of DBC, estimated savings from reduced hospital use were more than offset by pharmacy and professional service spending. Pharmacy spending change is likely due to improved adherence/regimen intensification. To promote sustainable TCOC payment models for DCM, consideration of medication effects is needed. Disclosure A.R. Montero: None. C. Betley: None. J.R. Brown: Employee; Spouse/Partner; LabCorp. D.M. Delia: None. N. Francis: None. L. Spicer: None. M.F. Magee: Consultant; Self; Mytonomy. Employee; Spouse/Partner; U.S. Food and Drug Administration. Research Support; Self; AstraZeneca, Eli Lilly and Company, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker’s Bureau; Self; American Diabetes Association, Pri-Med LLC. Other Relationship; Self; Endocrine Society.