Value-Based Payments and Incentives to Improve Care: A Case Study of Patients with Type 2 Diabetes in Medicare Advantage

Jesse Sussell, Kata Bognar, Taylor T. Schwartz, Jason Shafrin, John J. Sheehan, Wade Aubry, Dennis Patrick Scanlon

Research output: Contribution to journalArticle

Abstract

Objectives To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. Methods The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. Results At baseline, 24.4% of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27% at baseline to 49.5% (increased monitoring), 36.2% (intensification), and 57.1% (joint implementation of both interventions). However, overall star ratings increased for only 3.6%, 1.3%, and 4.8% of plans, respectively, by intervention. Projected per-member per-year rebate increases under the MA Star program were $7.71 (monitoring), $2.66 (intensification), and $10.55 (joint implementation). Conclusions The simulation showed that increased monitoring and treatment intensification would improve A1C levels; however, the resulting average increases in reimbursement would be small.

Original languageEnglish (US)
Pages (from-to)1216-1220
Number of pages5
JournalValue in Health
Volume20
Issue number8
DOIs
StatePublished - Sep 1 2017

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Medicare Part C
Type 2 Diabetes Mellitus
Motivation
Nutrition Surveys
Glycosylated Hemoglobin A
Therapeutics
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Sussell, Jesse ; Bognar, Kata ; Schwartz, Taylor T. ; Shafrin, Jason ; Sheehan, John J. ; Aubry, Wade ; Scanlon, Dennis Patrick. / Value-Based Payments and Incentives to Improve Care : A Case Study of Patients with Type 2 Diabetes in Medicare Advantage. In: Value in Health. 2017 ; Vol. 20, No. 8. pp. 1216-1220.
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abstract = "Objectives To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. Methods The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9{\%}). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. Results At baseline, 24.4{\%} of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27{\%} at baseline to 49.5{\%} (increased monitoring), 36.2{\%} (intensification), and 57.1{\%} (joint implementation of both interventions). However, overall star ratings increased for only 3.6{\%}, 1.3{\%}, and 4.8{\%} of plans, respectively, by intervention. Projected per-member per-year rebate increases under the MA Star program were $7.71 (monitoring), $2.66 (intensification), and $10.55 (joint implementation). Conclusions The simulation showed that increased monitoring and treatment intensification would improve A1C levels; however, the resulting average increases in reimbursement would be small.",
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Value-Based Payments and Incentives to Improve Care : A Case Study of Patients with Type 2 Diabetes in Medicare Advantage. / Sussell, Jesse; Bognar, Kata; Schwartz, Taylor T.; Shafrin, Jason; Sheehan, John J.; Aubry, Wade; Scanlon, Dennis Patrick.

In: Value in Health, Vol. 20, No. 8, 01.09.2017, p. 1216-1220.

Research output: Contribution to journalArticle

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T1 - Value-Based Payments and Incentives to Improve Care

T2 - A Case Study of Patients with Type 2 Diabetes in Medicare Advantage

AU - Sussell, Jesse

AU - Bognar, Kata

AU - Schwartz, Taylor T.

AU - Shafrin, Jason

AU - Sheehan, John J.

AU - Aubry, Wade

AU - Scanlon, Dennis Patrick

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N2 - Objectives To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. Methods The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. Results At baseline, 24.4% of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27% at baseline to 49.5% (increased monitoring), 36.2% (intensification), and 57.1% (joint implementation of both interventions). However, overall star ratings increased for only 3.6%, 1.3%, and 4.8% of plans, respectively, by intervention. Projected per-member per-year rebate increases under the MA Star program were $7.71 (monitoring), $2.66 (intensification), and $10.55 (joint implementation). Conclusions The simulation showed that increased monitoring and treatment intensification would improve A1C levels; however, the resulting average increases in reimbursement would be small.

AB - Objectives To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. Methods The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. Results At baseline, 24.4% of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27% at baseline to 49.5% (increased monitoring), 36.2% (intensification), and 57.1% (joint implementation of both interventions). However, overall star ratings increased for only 3.6%, 1.3%, and 4.8% of plans, respectively, by intervention. Projected per-member per-year rebate increases under the MA Star program were $7.71 (monitoring), $2.66 (intensification), and $10.55 (joint implementation). Conclusions The simulation showed that increased monitoring and treatment intensification would improve A1C levels; however, the resulting average increases in reimbursement would be small.

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