Healthcare services for people with diabetes (PWD) in the US are fragmented and uncoordinated, leading to broad variability in outcomes and annual healthcare costs per PWD, on a risk adjusted basis. The objective of our work is to test the hypothesis that PWD do better and utilize less resources, i.e. fewer complications, ER visits and hospitalizations, when cared for by an Endocrinologist, than when they are cared for by other types of clinicians.
To test our hypothesis we analyzed 100% of the Medicare Part A & B claims data from January 2021 through June of 2023. Using this data we identified 12 million Medicare PWDs, and we attributed each of them to an Endocrinologist, a PCP, an Other physician type, or No physician. We then risk adjusted the population based on the CMS Risk Adjustment Factor (RAF) methodology, and assessed risk-adjusted complication rates and resource utilization by physician, and physician attribution type (Endocrinologist, PCP, Other, None).
Through our analysis we found that PWD who regularly see an Endocrinologist throughout the year have fewer complications and utilize significantly less expensive healthcare resources than PWD who don’t regularly see an Endocrinologist. Preliminarily, PWD regularly cared for by an Endocrinologist spend $3,120 per year less than those not regularly cared for by an Endocrinologist, on a risk adjusted basis.
Based on these findings it is important to increase Endocrinology clinical capacity and access by creating multi-disciplinary clinical teams led by Endocrinologists that include Diabetes Educators, Dietitians, Nurse Practitioners and Nurses with expertise in diabetes who can care for many more PWDs. It is also important to incentivize the development of this model by moving Endocrinology care away from FFS into Value-Based Care arrangements that reward Endocrinologists for improving care and reducing costs rather than for generating more visits.
D. Terry: Employee; Valendo Health.
