The Impact of Reimbursement for Non-Face-to-Face Chronic Care Management on Health Utilization Among Patients With Type 2 Diabetes in Louisiana

Shao, Youlin; Stoecker, Charles; Hong, Dongzhe; Nauman, Elizabeth; Fonseca, Vivian; Hu, Gang; Bazzano, Alessandra N.; Kabagambe, Edmond K.; Shi, Lizheng

doi:10.1016/j.jval.2022.09.002

Cited by 8 publications

(14 citation statements)

References 21 publications

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“…One previous study using Medicare claims found that receiving NFFCCM improved patient satisfaction and adherence to recommended therapies and could significantly reduce health care costs among Medicare beneficiaries, likely through decreased use of inpatient hospital and postacute care services 10. We also found increased outpatient visits and decreased visits for hospitalizations and emergency department in our previous study 14. Our results further demonstrate the impact of NFFCCM on clinical outcomes in diabetes.…”

Section: Discussionsupporting

confidence: 85%

“…As a result of improvements in comprehensive biomarkers, NFFCCM service is cumulatively getting more patients to guideline suggested goals, and thereby potentially reduce the long-term risk of complications and costs. 14,26 We found patients receiving only noncomplex NFFCCM gained similar benefits as those receiving any NFFCCM. However, these findings were not always consistent with those among patients receiving complex NFFCCM.…”

Section: Discussionmentioning

confidence: 72%

“…The NNT for achieving 1 of 3 measures (HbA1c <7%, SBP <130 mm Hg, or LDL <110 mg/dL) is about 11 (9 of 100 patients). As a result of improvements in comprehensive biomarkers, NFFCCM service is cumulatively getting more patients to guideline suggested goals, and thereby potentially reduce the long-term risk of complications and costs 14,26…”

Section: Discussionmentioning

confidence: 99%

“…We excluded patients with missing baseline characteristics or no visits in the postperiod for statistical analysis. The baseline and postperiods were defined in one of our published studies 14…”

Section: Methodsmentioning

confidence: 99%

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The Impact of Reimbursement for Non–Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes

et al. 2023

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Aims: We evaluated the impact of reimbursement for non-face-to-face chronic care management (NFFCCM) on comprehensive metabolic risk factors among multimorbid Medicare beneficiaries with type 2 diabetes in Louisiana. Materials and Methods:We implemented a propensity score method to obtain comparable treatment (n = 1501 with NFFCCM) and control (n = 17,524 without NFFCCM) groups. Patients with type 2 diabetes were extracted from the electronic health records stored in REACHnet. The study period was from 2013 to February 2020. The comprehensive metabolic risk factors included the primary outcome of glycated hemoglobin (HbA1c) (as the primary outcome) and the secondary outcomes of body mass index (BMI), systolic blood pressure (BP), and low-density lipoprotein cholesterol.Results: Receiving any NFFCCM was associated with improvement in all outcomes measures: a reduction in HbA1c of 0.063% (95% CI: 0.031%-0.094%; P < 0.001), a reduction in BMI of 0.155 kg/m 2 (95% CI: 0.029-0.282 kg/m 2 ; P = 0.016), a reduction in systolic BP of 0.816 mm Hg (95% CI: 0.469-1.163 mm Hg; P < 0.001), and a reduction in low-density lipoprotein cholesterol of 1.779 mg/dL (95% CI: 0.988 2.570 mg/dL; P < 0.001). Compared with the control group, the treatment group had 1.6% more patients with HbA1c <7% (95% CI: 0.3%-2.9%; P = 0.013).Conclusions: Patients with diabetes in Louisiana receiving NFFCCM experienced better control of HbA1c, BMI, BP, and lowdensity lipoprotein outcomes.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Impact of Reimbursement for Non–Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes

et al. 2023

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“…3,4 Effective diabetes management requires a comprehensive approach, encompassing regular monitoring of blood glucose levels, glycated haemoglobin (HbA1c) levels, and lipid profiles, as well as individualized medical, nutritional and lifestyle interventions. [5][6][7] The pandemic highlighted the importance of alternative healthcare delivery models to address these challenges. Telehealth policies and strategies have been launched and promoted since the onset of the pandemic to provide healthcare services.…”

mentioning

confidence: 99%

Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID‐19 pandemic

Shao,

Shi,

Nauman

et al. 2023

Diabetes Obesity Metabolism

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AimTo evaluate the impact of telehealth use during the COVID‐19 pandemic on glycaemic control and other clinical outcomes among patients with type 2 diabetes.MethodsWe used electronic health records from the Research Action for Health Network (REACHnet) database for patients with type 2 diabetes who had telehealth visits and those who only received in‐person care during the pandemic. A quasi‐experimental method of difference‐in‐difference with propensity‐score weighting was implemented to mitigate selection bias and to control for observed factors related to telehealth use. Outcomes included glycated haemoglobin (HbA1c) and other clinical measures (low‐density lipoprotein [LDL] cholesterol, blood pressure [BP], and body mass index [BMI]).ResultsPatients using telehealth had better HbA1c control compared to those receiving in‐person care only during the pandemic. The telehealth group saw a significant average decrease of 0.146% (95% confidence interval [CI] −0.178% to −0.1145%; P < 0.001) in HbA1c levels over time. The proportion of patients with average HbA1c levels >7% decreased by 0.023 (95% CI −0.034, −0.011; P < 0.001) in the treatment group relative to the comparison group. Modest benefits in the control of LDL cholesterol levels, diastolic BP, and BMI were found in association with telehealth use.ConclusionsOur findings suggest that telehealth services contributed to better glycaemic control and management of other clinical outcomes in patients with type 2 diabetes during the pandemic. Factors unmeasured in this study would need to be further explored to better understand the impact of telehealth.

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Telehealth Use and Healthcare Utilization Among Individuals with Type 2 Diabetes During the COVID-19 Pandemic: Evidence From Louisiana Medicaid Claims

Shao,

Shi,

Nauman

et al. 2023

Diabetes Ther

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Introduction The impact of telehealth use on healthcare utilization is limited, especially among Medicaid beneficiaries with type 2 diabetes. Considering the rapid adoption of telehealth during the COVID-19 pandemic, this study examined associations between telehealth use and healthcare utilization among Medicaid beneficiaries with type 2 diabetes. Methods Using Louisiana Medicaid claims data from March 2019 to August 2021, the associations were examined using a difference-in-difference model with propensity score weighting. Demographic characteristics, baseline comorbidities and healthcare utilization, and zip code level environmental factors were included in the analysis. The monthly frequency of healthcare services, including in-person outpatient visits, inpatient visits, emergency department (ED) visits and hemoglobin A1C (HbA1C) tests, were measured as outcomes. Several sensitivity analyses were conducted across different subgroups. Results We included 48,992 beneficiaries with type 2 diabetes in the study of 27,340 beneficiaries in the telehealth group and 21,652 beneficiaries in the non-telehealth group. Of 1000 beneficiaries per month, the telehealth group had significantly more utilization compared to the non-telehealth group, with an increase of 195.049 in-person outpatient visits (95% CI: 166.169 to 223.929, p < 0.001), 3.816 inpatient visits (95% CI: 2.539 to 5.093, p < 0.001), 10.499 ED visits (95% CI: 7.287 to 13.712, p < 0.001) and 14.153 HbA1c tests (95% CI: 11.431 to 16.875, p < 0.001, respectively. Excluding beneficiaries who had ED or inpatient visits in the 30 days prior to receiving telehealth visits, overall ED visits significantly decreased for the telehealth group versus the non-telehealth group over time, by 9.456 visits (95% CI: – 12.356 to – 6.557, p < 0.001) per 1000 beneficiaries per month on average. Conclusion The study found that telehealth was associated with a significant increase in healthcare utilization in general but has the potential to decrease ED and inpatient utilization for some groups among low-income populations with diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-023-01508-z.

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The Impact of Reimbursement for Non-Face-to-Face Chronic Care Management on Health Utilization Among Patients With Type 2 Diabetes in Louisiana

Cited by 8 publications

References 21 publications

The Impact of Reimbursement for Non–Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes

The Impact of Reimbursement for Non–Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes

Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID‐19 pandemic

Telehealth Use and Healthcare Utilization Among Individuals with Type 2 Diabetes During the COVID-19 Pandemic: Evidence From Louisiana Medicaid Claims

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