Payer effects of personalized preventive care for patients with diabetes.

OBJECTIVES: To examine the effects of MD-Value in Prevention (MDVIP) enrollment on Medicare expenditures and utilization among fee-for-service (FFS) beneficiaries with diabetes over a 5-year period. STUDY DESIGN: We obtained participating physician and beneficiary enrollment lists from MDVIP and Medicare FFS claims data through the Virtual Research Data Center to compare changes in outcomes, before and after enrollment dates, with those of nonenrolled beneficiaries receiving primary care in the same local market. METHODS: We employed propensity score matching to identify comparison beneficiaries similar in observed characteristics and preenrollment trends. Individual fixed effects were used to control for time-consistent differences between treatment and comparison populations. RESULTS: We found that enrollment is statistically associated with reductions in outpatient expenditures, Medicare expenditures in year 5, emergency department (ED) utilization, and unplanned inpatient admissions, accompanied by significant increases in evaluation and management visits and expenditures. Total Medicare expenditures over the 5-year period, as well as all inpatient admissions, were not statistically different between the MDVIP and comparison groups. CONCLUSIONS: Our finding of reduced unplanned inpatient admissions and ED utilization supports the previous findings regarding MDVIP enrollees. We did not find significant changes in overall third-party expenditures, although savings were estimated in year 5, the last year of observation, and may occur later. Our approach, however, strengthens controls for baseline characteristics of the population and uses a comparison population drawn from the same markets who do not experience the loss of their primary care physician at the time of enrollment.

Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?

AIMS: The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)? BACKGROUND: In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries. DESIGN: Cross-sectional quantitative analysis of 2012 Medicare claims data. METHODS: A 5% Standard Analytic File of 2012 Medicare claims data for beneficiaries with Type 2 diabetes were analysed. A medical productivity index was used to stratify patients as healthiest and least healthy who were seen by either nurse practitioners only or primary care physicians exclusively. Included in the analyses were health services utilization, health outcomes and healthcare cost variables. RESULTS: The patients in the nurse practitioner only group, overall and stratified by medical productivity index status, had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare services utilization, patient health outcomes and healthcare costs. CONCLUSIONS: These findings inform current healthcare workforce conversations regarding healthcare quality, outcomes and costs. Our results suggest nurse practitioner engagement in chronic care patient management in primary care settings is associated with lower cost and better quality health care.