The Impact of New Payment Models on Quality of Diabetes Care and Outcomes

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.

How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review

“…If models of healthcare continue to shift from feefor-service to patient-centered medical homes and accountable care organizations [37,89], the emphasis to deliver high-value care that improves important health outcomes should continue to grow. An additional trend that may further the translation of PA and other behavioral interventions into clinical practice is the recent Medicare approval of Chronic Care Management funding codes in 2015 to reimburse clinical counseling and coordination of care that is delivered outside of face-to-face clinic visits [90].…”

“…We adapted an existing RE-AIM rating tool that was used to assess these practical feasibility factors in a prior review article [33]. Scoring for both RE-AIM and PRECIS-2 factors was assessed from the perspective of a patient-centered medical home (PCMH), rather than a traditional primary care clinic, as the PCMH model of care is rapidly spreading [35] and provides a model for population health teams to deliver behavior change interventions more optimally than traditional primary care practices [36,37].…”

Clinical Use of Continuous Glucose Monitoring in Adults with Type 2 Diabetes

“…Most diabetes P4P agreements are focused on measures of HbA1c, blood pressure, LDL cholesterol, tobacco cessation, and aspirin use for their entire patient population with diabetes. 54,55 These population health measures are meant to reflect good quality diabetes care of a population of patients, but what happens at the patient level of care delivery?…”

Dysglycemia-Based Chronic Disease: An American Association of Clinical Endocrinologists Position Statement

“…Introducing communications technology has been shown to facilitate adoption of a diabetes chronic care model and use of self-management strategies, while also lowering costs (170). Future economic studies on T2D prevention will need to concentrate on context, scope, payment models, income levels, self-management support, and impact on the labor market (169)(170)(171)(172). The economic model will also need validation for patients of different cultures and ethnicities, both of which are associated with differences in key mechanistic drivers, phenotypic expression of disease, and conversion rates among the DCBD stages (173)(174)(175)(176).…”