capstone presentation _ nnd

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.