The Alabama Care Plan: Assessing the Impact of Regional Care Organizations on Diabetes Outcomes in a Sample of Alabama Medicaid Recipients

 描述（由申请人提供）：尽管与糖尿病预防和管理相关的科学知识取得了进展，但糖尿病患病率、并发症和费用仍在持续上升。用于糖尿病护理的大部分美元用于急诊科就诊，住院治疗和糖尿病并发症的管理。改变美国糖尿病流行的轨迹可能需要一种全新的慢性病管理和报销方法，强调疾病预防和管理。问责护理组织（ACO）可能是这样一种方法。在这种模式下，一个组织负责照顾人口，收到资本付款，并且可能有资格获得所实现的任何节省的一部分和/或因超过设定目标的任何支出的一部分而面临风险。因此，ACO已被提议作为同时改善人口健康和降低医疗保健成本的手段。亚拉巴马医疗补助计划正在经历一个重大转变，从传统的服务模式收费到建立ACO（在亚拉巴马称为RCO或区域护理组织）。亚拉巴马护理计划是6个试用RCO之一，将为B区的7万多名医疗补助接受者提供护理，其中11%患有糖尿病。2015年4月，VIVA Health，一家当地的管理式医疗机构，也是亚拉巴马医疗计划的牵头实体，开始创建医疗协调团队，与个人目前的医疗保健提供者合作，组成一个更大的“健康之家”。“这一分阶段的过渡为我们提供了一个独特的机会，以评估与糖尿病有关的报销和医疗保健提供政策变化的影响。根据这项建议，调查人员将进行一项 严格评估这一转变对三个方面结果的影响：人口健康、护理经验和人均成本。具体目标是：1.检查糖尿病相关人群健康指标的变化，包括血糖控制（HbA 1c）和糖尿病护理指标（季度HbA 1c，年度眼科检查）; 2.使用电话管理调查和定性访谈对健康之家登记的2型糖尿病患者子集的护理经验进行检查; 3.与RCO实施前的糖尿病护理相比，检查新实施的RCO和健康之家的医疗保健利用率和总体成本效益的变化。使用2010年至2019年开始的Medicaid数据，研究者将对区域B内入组者的数据进行中断时间序列分析和差异中差异分析，以比较区域B随时间的变化与3个南部非ACO州随时间的变化。多学科的研究人员团队在糖尿病研究，CMS数据的使用，调查管理和定性方法方面具有专业知识。亚拉巴马是美国糖尿病发病率最高的地区。因此，这项研究可能对糖尿病管理的新方法具有重要的地方和国家政策意义。

 DESCRIPTION (provided by applicant):Despite advances in the scientific knowledge related to diabetes prevention and management, diabetes prevalence, complications, and costs continues to rise. A majority of the dollars that go towards diabetes care are spent on Emergency Department visits, hospitalizations, and the management of diabetes complications. Changing the trajectory of the diabetes epidemic in the United States may require a fundamentally new approach to chronic disease management and reimbursement that emphasizes disease prevention and management. Accountable Care Organizations (ACOs) could be such an approach. Under this model, an organization is charged with the care of a population, receives a capitated payment and may be eligible for either a share of any savings achieved and/or at risk for a portion of any spending over the set target. As such, ACOs have been proposed as a means to simultaneously improve population health and reduce health care costs. The Alabama Medicaid program is undergoing a major transformation from a traditional fee for service model to the establishment of ACOs (referred to in Alabama as RCOs or Regional Care Organizations). The Alabama Care Plan, one of 6 probationary RCOs, will assume care for over 70,000 Medicaid recipients in Region B, 11% of whom have diabetes. In April 2015, VIVA Health, a local managed care organization and the lead entity in the Alabama Care Plan, began creating care coordination teams that will work with individuals' current health care providers to comprise a larger "health home." This phased transition provides a unique opportunity for us to assess the impact of policy change related to reimbursement and the delivery of health care as it relates to diabetes. With this proposal, investigators will conduct a rigorous evaluation of the impact of this transition on outcomes in three dimensions: health of a population, experience of care, and per capita cost. The specific aims are: 1. To examine changes in diabetes related population health measures, including glycemic control (HbA1c) and indicators of diabetes care (quarterly HbA1c, annual eye exam); 2. To examine patient experience of care using a telephone-administered survey and qualitative interviews with a subset of individuals with type 2 diabetes enrolled in the Health Home; and 3.To examine changes in health care utilization and overall cost effectiveness of the newly implemented RCO and Health Home compared to diabetes care before RCO implementation. Using Medicaid data beginning in 2010 through 2019, investigators will conduct interrupted time series analyses of data from enrollees within Region B and difference-in- differences analyses to compare changes over time in Region B with changes over time in 3 southern, non- ACO states. The multidisciplinary team of investigators has expertise in diabetes research, use of CMS data, survey administration and qualitative methods. Alabama has the highest rate of diabetes in the United States. As such, this study could have important local and national policy implications for new approaches to diabetes management.