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Vendor-based program fails to improve care in Medicare patients with diabetes
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The use of a vendor-based disease management pilot program among fee-for-service Medicare patients does not appear to improve diabetes care or mitigate racial/ethnic disparities among these patients, according to recent findings.
In the intervention-control cohort study, researchers reviewed Medi-Cal claims data for 5,921 fee-for-service Medi-Cal beneficiaries with diabetes enrolled in the California Department of Health Care Services from September 2005 to August 2010. Individuals identified for inclusion were aged 22 to 75 years, diagnosed with type 1 or type 2 diabetes, and lived in two intervention counties (n = 2,933) or in eight control counties (n = 2,988). A 3-year, telephone-based and patient-focused disease management program was provided by a private vendor from September 2007 to August 2010.
The study’s outcomes of interest, defined by the Healthcare Effectiveness Data and Information Set (HEDIS) included receipt of a minimum of one HbA1c test within the previous year; at least one LDL screening within the previous year; and one or more retinal examinations during the measurement year or previous year. The main independent variable of interest was race/ethnicity, which included whites, Latinos, blacks and Pacific Islanders. Chi-square tests were used to determine unadjusted rates of the outcome measures and distribution of populations by characteristics in the intervention and control counties.
Before implementation of the disease management program, the researchers found racial/ethnic discrepancies in all three testing outcomes in the intervention counties. In these counties, racial minorities such as blacks (0.66; 95% CI, 0.62-0.7) and Latinos (0.77; 95% CI, 0.74-0.8) had lower rates of HbA1c testing vs. whites (0.83; 95% CI, 0.81-0.85). Pacific Islanders and other racial/ethnic groups in the intervention counties demonstrated similar rates of HbA1c testing vs. whites. In the control counties, the prevalence of annual HbA1c testing did not differ among racial/ethnic groups, with the exception of a higher rate of testing among Pacific Islanders (0.78; 955 CI, 0.75-0.81) vs. whites (0.71; 95% CI, 0.68-0.74). The differences in testing rates among blacks and Latinos vs. whites remained persistent in the intervention counties after implementation of the program, whereas the differences in testing rates were attenuated among Asian Americans and Pacific Islanders.
“Although this and other studies have demonstrated a range of efficacy for disease management programs, the effectiveness of vendor-based disease management programs in reducing racial/ethnic disparities in diabetes care for Medicaid fee-for-service population remains questionable,” the researchers wrote. “Public and private efforts to improve self-management skills and care-seeking behaviors of patients with diabetes should carefully examine whether vendor-based and patient-focused disease management programs can improve quality of care.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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