Introduction & Objective: Outcomes for people with diabetes in rural areas are worsening, widening rural disparities. The goal of Diabetes On Track is to improve outcomes for people living with pre-diabetes and type 2 diabetes in rural Nebraska. One intervention has been a value-based incentive model for primary care providers (PCPs) in two communities, with aims to improve diabetes-related quality metrics and encourage health systems to recognize benefits of joining value-based contracts and achieving shared savings.
Methods: Two rural communities were identified, and primary care clinic leadership was engaged in each community. Individual provider dashboards were created for diabetes-related metrics, allowing PCPs to monitor progress. Baseline data was collected for each site, and target and stretch goals were created for 6-month periods over 2 years. Data were collected on a1c monitoring and control (A1c <9%), as well as screening for dyslipidemia, nephropathy, and retinopathy over a rolling 12-month period.
Results: Clinic A incentivized PCPs directly; Clinic B did not. After 6 months, Clinic B showed small improvements in nephropathy and retinopathy screening, while other metrics remained stable. Clinic A showed improvement in all metrics and is on track to achieve stretch goals set for the entire 2-year program. Some of this improvement is due to resolving lab mapping issues and purchasing a retinal camera. Clinic A improved both A1c completion and control by 6% from baseline (ending at 94% and 84%, respectively). Nephropathy and retinopathy screening improved by 270% and 38%, respectively. Lipid monitoring increased by 25%. Clinic A is joining an accountable care organization in 2024.
Conclusion: Providing real-time patient panel data and incentivizing PCPs contributed to improved diabetes-related quality metrics. This pilot is a critical component of a comprehensive diabetes program, allowing rural health systems to recognize the importance of the shift towards value-based care.
L.A. Eiland: Advisory Panel; Provention Bio, Inc., Cecelia Health. S.M. Mohring: None. S. Keegan: Consultant; Tandem Diabetes Care, Inc. S. Nygaard: None. K. Pullyblank: None. C. Desouza: Advisory Panel; Novo Nordisk, Bayer Inc., Madrigal Pharmaceuticals, Inc. Other Relationship; ADA/ACC Diabetes by Heart Program. Advisory Panel; Asahi Kasei.
Private gift received through the University of Nebraska Foundation from the Diabetes Care Foundation.
