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Natural experiments of the impact of population-targeted health policies to prevent diabetes and its complications
Investigator (PI): Shi, Lizheng
Performing Organization (PO): (Current): Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management / (504) 988-5428
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2022
Record Source/Award ID: PCORI/NEN-1508-32257
Funding: Total Award Amount: $2,447,929
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Due to the prevalence of comorbidities among medically complex patients with type 2 diabetes, care coordination in diabetes management remains a major public health concern in the United States, especially in Louisiana where mortality and morbidity from poor glycemic control, diabetes complications, and cardiovascular disease are higher than in other regions of the United States. Non-face-to-face care coordination for chronic care management (CCM) had not been reimbursed by CMS until a recently implemented CPT code (99490) enabled primary care providers to receive payments (approximately $40.39 per month per qualifying patient) for this type of CCM under the 2015 Medicare Physician Fee Schedule. These chronic care management services specifically include non-face-to-face care planning and management for patients with two or more chronic conditions. However, progress toward better chronic care management has been hindered by the lack of rigorous experiments in testing health policy interventions to inform efforts by health systems, communities, and stakeholders (patients, caregivers, providers). In addition, there is a lack of impact evaluations on patient-reported outcomes. To address these critical knowledge gaps, we propose using a natural experiment design to examine the impacts of the new CPT code for chronic care management on patient-centered outcomes. We will collaborate with partners in the Louisiana Clinical Data Research Network (LaCDRN) who serve more than 90,000 patients with type 2 diabetes mellitus in Louisiana. The first aim is to evaluate the barriers to and facilitators for implementing CMS chronic care management services overall and within each of the health systems. The analyses will identify critical elements of the programs that will enhance the reach, effectiveness, adoption, implementation, and maintenance of these strategies in the diverse LaCDRN diabetes populations. The second aim is to examine the impacts of the CMS reimbursement for non-face-to-face care coordination to improve health outcomes (e.g., glycemic control, CVD risk reductions, lifestyle modification, and patient-reported outcomes) and health care utilizations between the created comparison groups based on age eligibility (Medicare vs. non-Medicare) as a natural experiment. The study questions and study outcomes will be patient-centered, with the engagement of patients and stakeholders, including health systems and payers. This proposal has received input from the LaCDRN Diabetes Advisory Groups (DAGs), health system leadership, and payer representatives. Two DAG members will serve as research partners on the project's steering committee and advisory panel. Broader patient and stakeholder engagement will also be planned and implemented on a regular basis across all phases of this natural experiment. The potential for further implementation and scale-up of the policy to other populations and settings would bring value to multiple health systems and non-Medicare populations.
MeSH Terms:
  • Centers for Medicare and Medicaid Services, U.S.
  • Chronic Disease
  • Diabetes Complications /economics
  • /*prevention & control
  • Diabetes Mellitus, Type 2 /economics
  • /*prevention & control
  • * Health Policy
  • Health Services Accessibility
  • Health Services Research
  • Humans
  • Leadership
  • Life Style
  • Louisiana
  • Medicare
  • Outcome Assessment, Health Care
  • Patient-Centered Care
  • Public Health
  • Reimbursement Mechanisms
  • United States
Country: United States
State: Louisiana
Zip Code: 70112
UI: 20162176
CTgovId: NCT03136471
Project Status: Ongoing
Record History: ('2019: Project extended to 2022',)