From the 2024 HVPA National Conference
Asra Kermani MD (University of Texas Southwestern Medical Center), Usha Kollipara RD (Southwestern Health Resources), Brent Goldberg MBA, Juan Acosta B.S.
Background
Poor glycemic control is directly related to higher total cost of care and a higher probability of hospitalization compared with good glycemic control. Reduction in HbA1c was associated with significant cost savings within 1 to 2 years of improvement. Population-level disease management strategies are particularly relevant for accountable care organizations (ACOs) and other integrated delivery systems. Access to programs utilizing lifestyle and diet modification is limited, though they may reduce HbA1c by up to 1%.
Aim
To create a population-health focused nutrition and lifestyle program and measure its effectiveness in improving diabetes control in a large ACO (Southwestern Health Resources).
Methods
A comprehensive population health-focused diabetes education program was created which included the following: group classes, biweekly one-to-one counseling sessions (virtual and in-person), grocery store tour with a dietitian; practical tools for self-management such as cookbooks, portion control plate and diabetes passport; public-facing website with links to cooking videos, recipes and publicly available food insecurity resources. Members either in poor diabetes control (most recent A1c in the previous 3 months >9.0%) or identified as high risk for rapid progression by our predictive model were outreached and enrolled in the program. The average program duration was 3 months, and enrollment was limited to Medicare or Medicare Advantage members. Claims and EMR data were used to track HbA1c, hospital and ED visits, total cost of care (TCOC), medication adherence. HbA1c change at 3 months and 6 months after program completion was calculated for both enrolled and non-enrolled cohorts. TCOC, emergency department (ED) visits, unplanned hospital admits, and 30-day readmits were obtained and stratified by diabetes control (most recent HbA1c 9.0% or less) or poor control (most recent HbA1c >9.0%).
Results
150 members were outreached between January to August 2023 and 62 members were enrolled and completed the lifestyle-based education program, whereas 88 members declined. Mean HbA1c decline at 3 and 6 months post completion period of the program is shown in Table 1. The cost and utilization differences of controlled vs. poorly controlled diabetes population in our network is shown in Table 2. Diabetes control was associated with lower TCOC, unplanned hospital admits, ED use and readmits. We analyzed the TCOC reduction among diabetes poor control members with similar reduction in HbA1c (>1%) for the same time frame and observed a reduction in TCOC of $938.
Conclusion
Our findings are in line with the evidence that lifestyle-based diabetes education programs provided by registered dietitians are effective in improving clinical outcomes. Additionally, we propose that these interventions can be effective in reducing total cost care in accountable care organizations. Such programs are scalable and cost-effective.