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LESSONS FROM AN EMERGING ACO IN SOUTHEASTERN NC
Can integrated provider networks reduce Medicare spending and improve outcomes in diabetics?
Nisel Desai
MSPH/JD Candidate
Class of 2018
Policy Shapes Chronic Disease Management■ Implementing new health care legislation: challenges and opportunities ■ Chronic Care Management in the Era of the ACO
Population Health
■ Diabetes in North Carolina ■ Moving Diabetes Treatment to the Outpatient Setting ■ Regional Hospital System Invests in Chronic Chare Management through ACO
Research Questions
Of the diabetic patients treated within the health system, is there a difference in management and outcomes of ACO beneficiaries and traditional Medicare beneficiaries?
Is there a quantitative model that can determine if this patient population can benefit from progressive outpatient diabetes delivery models?
Methods
■ Hospital Financial Data from October 2014 to June 2015 ■ Study population ■ Inclusion Criteria ■ Exclusion Criteria
A Closer Look at the Diabetic Patient PopulationDiabetes Type 1 vs Type 2 Complexity of Condition Nature of Admission ACO Beneficiary Status
An overview of Diabetic Admissions from October 2014 to June 2015
ICD-9 Codes: Categorical Predictor Variables
Statistical Analyses
Logistic Regression Models Glycemic Control Treatment Setting
Table 1 Effect of Treatment Setting and Complexity of Condition on Glycemic Control amongst Type 2 Diabetics
Table 2 Effect of glycemic control and complexity of condition on admission setting amongst Type 2 diabetics.
Conclusion
- ACO Initiation and Expansion is a very deliberate process - Diabetics who are admitted on an inpatient basis are less likely to achieve good glycemic control, and have more complicated conditions. This is unsustainable and consistent with the literature.
Discussion
Study Limitations - ACO operational as of January 1, 2015 - Scope is limited
Future Directions -Refine Analysis -Repeat Analysis on ACO after it has been operational for two years. -Repeat Analysis on other health systems - Earn a J.D. so that I may fully appreciate the scope of the Affordable Care Act and its emerging impact.
QUESTION&ANSWERThank you for your time.