Moin Tannaz, Harwood Jessica M, Mangione Carol M, Jackson Nicholas, Ho Sam, Ettner Susan L, Duru O Kenrik
David Geffen School of Medicine at UCLA.
HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health System.
Med Care. 2020 Jun;58 Suppl 6 Suppl 1(Suppl 6 1):S40-S45. doi: 10.1097/MLR.0000000000001318.
BACKGROUND/OBJECTIVES: Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by UnitedHealthcare to improve care for Medicaid beneficiaries. We examined changes in costs and utilization for Medicaid beneficiaries with diabetes assigned to ACC versus usual care practices.
Interrupted time series with concurrent control group analysis, at the person-month level. The ACC was implemented in 14 states, and we selected comparison non-ACC practices from those states to control for state-level variation in Medicaid program. We adjusted the models for age, sex, race/ethnicity, comorbidities, seasonality, and state-by-year fixed effects. We examined the difference between ACC and non-ACC practices in changes in the time trends of expenditures and hospital and emergency room utilization, for the 4 largest categories of Medicaid eligibility [Temporary Assistance to Needy Families, Supplemental Security Income (without Medicare), Expansion, Dual-Eligible].
SUBJECTS/MEASURES: Eligibility and claims data from Medicaid adults with diabetes from 14 states between 2010 and 2016, before and after ACC implementation.
Analyses included 1,200,460 person-months from 66,450 Medicaid patients with diabetes. ACC implementation was not associated with significant changes in outcome time trends, relative to comparators, for all Medicaid categories.
Medicaid patients assigned to ACC practices had no changes in cost or utilization over 3 years of follow-up, compared with patients assigned to non-ACC practices. The ACC program may not reduce costs or utilization for Medicaid patients with diabetes.
背景/目的：患有糖尿病的医疗补助受益人群有复杂的护理需求。 accountable care communities（ACC）项目是联合健康集团实施的一项实践层面的干预措施，旨在改善对医疗补助受益人的护理。我们研究了被分配到ACC的糖尿病医疗补助受益人与接受常规护理的受益人在成本和医疗服务利用方面的变化。
在个人月层面进行的中断时间序列分析，并设有同期对照组。ACC项目在14个州实施，我们从这些州中选择了非ACC的对照实践，以控制医疗补助项目在州层面的差异。我们对模型进行了年龄、性别、种族/族裔、合并症、季节性以及逐年的州固定效应调整。我们研究了ACC与非ACC实践在支出、住院和急诊室利用时间趋势变化方面的差异，针对医疗补助资格的4个最大类别[对贫困家庭的临时援助、补充保障收入（无医疗保险）、医保扩展计划、双重资格者]。
研究对象/测量指标：2010年至2016年期间，14个州患有糖尿病的成年医疗补助受益人的资格和索赔数据，涵盖ACC实施前后。
分析纳入了66450名患有糖尿病的医疗补助患者的1200460个人月数据。相对于对照组，在所有医疗补助类别中，ACC的实施与结果时间趋势的显著变化无关。
与被分配到非ACC实践的患者相比，被分配到ACC实践的医疗补助患者在3年随访期间的成本或医疗服务利用没有变化。ACC项目可能无法降低患有糖尿病的医疗补助患者的成本或医疗服务利用。
