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Value of Primary Care Diabetes Bundle Management: Long-Term Impact on Cost

Publication Date

4-30-2015

Keywords

diabetes care, cost of care

Abstract

Background/Aims: In 2006, Geisinger’s primary care clinics implemented an all-or-none diabetes bundle system of care, which has been shown to be associated with reduced risk of retinopathy, stroke and myocardial infarction (Bloom et al., 2014). This follow-up study estimates long-term cost savings associated with patients’ exposure to the all-or-none bundle of measures for primary care management of diabetes.

Methods: Claims data from Geisinger Health Plan were used to identify those who met Healthcare Effectiveness Data and Information Set criteria for diabetes and had two or more diabetes-related encounters on different dates before 2006. A cohort of 2,426 members exposed to the diabetes bundle was then compared against a propensity score-matched comparison cohort of 1,836 members from January 1, 2006, through June 30, 2013. A set of generalized linear models with log link and gamma distribution was estimated. The key explanatory variable was each member’s bundle exposure measured in month. The dependent variables were inpatient and outpatient facility costs, professional cost and total medical cost measured on a per-member-per-month (PMPM) basis.

Results: During the first year of exposure, the total cost of care including prescription drugs rose 1.5% ($9/$604; P=0.67) PMPM. Also during the first year of the diabetes bundle exposure, there were statistically significant increases in the outpatient (12.6% [$19/$150]) and professional (10% [$15/$153]) PMPM costs (P<0.05). However, in the third and fifth years, there were approximately 10% ($67/$666) and 16% ($118/$764) PMPM total cost savings, respectively (P<0.05). Over the entire study period, the estimated total medical cost saving was 6.8% ($44/$650; P<0.05) PMPM. The main source of the savings was reductions in inpatient facility cost, which accounted for approximately half of the total cost reductions.

Discussion: A system of care with an all-or-none bundled measure used in primary care for patients with diabetes may reduce long-term cost of care while improving health outcomes.

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Submitted

March 30th, 2015

Accepted

April 28th, 2015