Previously unrecognized trends in diabetes consumption clusters in medicare.

OBJECTIVE: To examine the annual cost profiles of Medicare beneficiaries with diabetes to identify patterns in their consumption of benefits. METHODS: Retrospective expenditure data were collected from Medicare records. Beneficiaries with diabetes were grouped into 5 consumption clusters ranging from "crisis consumers" at the high end to "low consumers" at the low end. RESULTS: The percentages of beneficiaries and expenditures for the consumption clusters remained generally constant from year to year. As expected, most of Medicare's budget each year was spent on crisis, heavy, and moderate consumers. However, a notable proportion of low and light consumers from one year go on to become crisis and heavy consumers in subsequent years. A review of total 2001 through 2006 inpatient costs for the year 2000 clusters revealed that 47% of these costs were for year 2000 low and light consumers and only 27% were for year 2000 crisis and heavy consumers. CONCLUSIONS: This analysis revealed previously unrecognized trends, whereby a notable proportion of low and light consumers during one year went on to become crisis and heavy consumers in subsequent years, representing a large proportion of inpatient costs. These findings have important implications for disease management programs, which typically focus intervention efforts exclusively on crisis and heavy consumers.

Increasing access to health care providers through medical home model may abolish racial disparity in diabetes care: evidence from a cross-sectional study.

OBJECTIVES: We hypothesized that the medical home model is an effective intervention to decreasing health care disparities in minority patients with diabetes. SETTING: Set in a community-based health initiative in Jacksonville, Florida, the study's mission was to support and enhance the primary care infrastructure in an effort to improve quality of care and increase access while reducing costs. INTERVENTION: We preformed a retrospective analysis of outcomes on 457 patients identified by registry specialists and enrolled in the diabetes rapid access program (DRAP). Data were obtained on 457 diabetic patients enrolled in the 6 clinic centers of the program between June 1, 2006, and December 31, 2009. MAIN OUTCOME MEASURES: Improvements in hemoglobin A1c and proportion of patients with hemoglobin A1c of more than 8% according to gender, race, and clinic location. RESULTS: The average hemoglobin A1c at the beginning of the study was 8.2% (+/-2.3), and decreased significantly by an average of 0.5% (p<.005). The mean improvement in hemoglobin A1c did not differ significantly by clinic location, race, or gender. Both African American and Caucasian patients as well as men and women with a hemoglobin A1c of at least 8% showed a significant improvement in their A1c after the intervention (p<.005). CONCLUSIONS: The DRAP medical home model presents an opportunity to decrease disparities in care and improve diabetes care.