(395) Impact on accountable care organization diabetes population; health plan pharmacist value-based care engagement

Background: : Value-based care partnerships with accountable care organizations (ACOs), such as Blue Cross NC’s Blue Premier (BP), offer a pathway to improving quality of care for members with diabetes. Research is essential to assess the long-term impact of these partnerships on both clinical and economic outcomes.

Objective: : To assess the impact on cost trends of a health plan led diabetes initiative within a value-based care framework.

Methods: : Health plan pharmacists shared data regularly with ACOs specific to diabetes for financially accountable members. Member history, including medical and pharmacy claims, adherence, and lab data, was presented through reports, verbal discussions, and integrated visual tools, highlighting member examples from the ACO attributed population. Actions were focused on deprescribing duplicate therapies such as glucagon like peptide-1 receptor agonist (GLP1) and dipeptidyl peptidase-4 inhibitor medications, stockpiling of GLP1 medications, cost-efficient use of medications and gaps in diabetes quality measures.
This study analyzed 52,074 commercial members who maintained continuous coverage from 2023 through 2024. It included active members with a diabetes episode and at least one fill of an antidiabetic medication within the past 27 months. The study population was divided into two groups: members attributed to a BP primary care provider (intervention group) and those not attributed to a BP primary care provider (comparison group). Members with an annual total cost of care exceeding $250,000 were excluded. A risk adjusted fixed-effects analysis was conducted to evaluate temporal changes in total and diabetes-related costs between the intervention group and the comparison group.

Results: : The health plan and ACO partnership supported control of the financial trend of members with diabetes in Blue Premier. From 2023 to 2024, increasing trends in total medical expenses and diabetes-related medical expenses were significantly smaller by $51 and $11 per-member-per-month (p values = 0.038 and 0.001), respectively among the intervention group compared to the comparison group. In contrast, no statistically significant differences were observed between the groups in the temporal trends of total prescription expenses and diabetes-related prescription expenses (p values = 0.158 and 0.332).

Conclusions: : The value-based care partnership incentivized ACOs to increase uptake of diabetes related initiatives. By integrating pharmacy discussions and facilitating shared data, health plans and ACOs may further improve patient care while managing healthcare utilization.

Sponsorship:: None