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 language | English (US) |
|---|---|
| Pages (from-to) | 1216-1220 |
| Number of pages | 5 |
| Journal | Value in Health |
| Volume | 20 |
| Issue number | 8 |
| DOIs | |
| State | Published - Sep 1 2017 |
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All Science Journal Classification (ASJC) codes
- Health Policy
- Public Health, Environmental and Occupational Health
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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 journal › Article
TY - JOUR
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
PY - 2017/9/1
Y1 - 2017/9/1
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.
UR - http://www.scopus.com/inward/record.url?scp=85020415676&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020415676&partnerID=8YFLogxK
U2 - 10.1016/j.jval.2017.03.016
DO - 10.1016/j.jval.2017.03.016
M3 - Article
C2 - 28964455
AN - SCOPUS:85020415676
VL - 20
SP - 1216
EP - 1220
JO - Value in Health
JF - Value in Health
SN - 1098-3015
IS - 8
ER -