State Innovation Model Initiative Impacts on Diabetes Prevention and Management

 描述（由申请人提供）：为了刺激卫生系统转型，医疗保险和医疗补助服务中心（CMS）启动了国家创新模式（SIM）计划，自2013年以来，已投入超过10亿美元用于国家计划，试点测试和实施支付和交付系统改革。SIM倡议是一项正在进行的、自然发生的联邦-州“政策干预”，为各州提供财政和技术支持，以开发和测试州主导的多付款人医疗保健支付和服务提供模式。这项联邦-州计划的目标是改善卫生系统的绩效，提高病人护理的质量，并降低该州所有居民的医疗保健费用。随着各州投资于激励措施的转型重组， 通过使用医疗保健和医疗服务系统，预计SIM倡议将改善整体健康状况，包括社区大部分人群的糖尿病风险和健康状况。为了实现SIM倡议的目标，大多数SIM州都把重点放在慢性病上，特别是糖尿病。我们提出了一个自然的实验，严格设计，以优化的能力，提请因果推理。使用来自多个来源的不同数据，我们将评估这一以人口为目标的政策，以评估多个层面的结果，包括州、县、医生组织和交付系统层面。从2015年到2019年，我们将监测和跟踪与预防和管理糖尿病并发症相关的支付和交付系统改革。这将针对18个有目的地采样的状态进行：6个“第1轮”状态、6个“第2轮”状态和6个“等待控制”状态。使用这些政策数据，我们将制定一个分类的国家SIM实施经验研究SIM实施如何影响实践实施的以病人为中心的医疗之家（PCMH）模式和参与负责任的护理组织（ACO）。我们将使用患者的倾向评分匹配在一个阶梯楔形研究设计，以检查SIM计划在各州的分阶段实施的影响。我们将评估SIM计划对糖尿病相关健康行为（2011-2018年）和糖尿病住院（2011-2017年）的影响，包括“第1轮”、“第2轮”和“等待控制状态”。将探讨作为各州SIM计划一部分实施的交付系统和支付改革活动的影响。最后，我们估计了SIM倡议在糖尿病护理预防和管理方面的改进的经济影响，并探讨了SIM州经济影响的异质性。拟议的合作项目将为州和地方卫生官员以及公共卫生和医疗保健提供利益相关者提供关于SIM倡议对改善糖尿病预防和管理的影响的可操作数据和分析。

 DESCRIPTION (provided by applicant): To stimulate health system transformation, the Centers for Medicare and Medicaid Services (CMS) launched the State Innovation Model (SIM) Initiative, which since 2013, has invested more than 1 billion dollars in state efforts to plan, piot test, and implement payment and delivery system reforms. The SIM Initiative is an ongoing, naturally occurring federal-state "policy intervention" that provides financial and technical support to states for development and testing state-led multi-payer health care payment and service delivery models. The goals of this federal-state program are to improve health system performance, improve the quality of patient care, and decrease health care costs for all residents of the state. As states are investing in transformational restructuring of incentives and delivery systems, the SIM Initiative is anticipated to improve health status overall, including diabetes risk and health status in large segments of the community. In order to achieve SIM Initiative goals, most SIM states are focusing on chronic illness, in general, and diabetes, in particular. We propose a natural experiment rigorously designed to optimize the ability to draw causal inferences. Using diverse data from multiple sources we will assess this population-targeted policy to assess outcomes at multiple levels, including state, county, and physician organization and delivery system levels. From 2015 to 2019, we will monitor and track payment and delivery system reforms relevant to preventing, and managing complications of, diabetes. This will be done for 18 purposively sampled states: 6 "Round 1" states, 6 "Round 2" states, and 6 "waiting control" states. Using these policy data, we will develop a taxonomy of state SIM implementation to empirically examine how SIM implementation affects practice implementation of the patient-centered medical home (PCMH) model and participation in accountable care organizations (ACOs). We will use propensity score matching of patients in a stepped wedge research design to examine the impact of the staged implementation of SIM plans across the states. We will estimate the impact of the SIM Initiative on diabetes-related health behaviors (2011-2018) and hospitalizations due to diabetes (2011-2017) for "Round 1" vs. "Round 2" vs. "waiting control states". The influence of delivery system and payment reform activities implemented as part of each states' SIM plan will be explored. Finally, we estimate the economic impact of the SIM Initiative's improvements in diabetes care prevention and management and explore heterogeneity in economic impacts across SIM states. The proposed collaborative project will yield actionable data and analyses to state and local health officials, and public health and health care delivery stakeholders on the impact of the SIM Initiative on improvements on diabetes prevention and management.