Management Practices and Costs Associated with Diabetes Clinical Metrics as Measured by Healthcare Effectiveness Data and Information Set (HEDIS)

Abstract

Abstract Background The clinical outcomes of diabetes can be influenced by primary care providers’ (PCP) practices. This study explores the association between PCP practices and performance measured by established diabetes metrics and related costs.Methods Electronic medical records were used to gather diabetes metrics derived from the Healthcare Effectiveness Data and Information Set and to rank PCP practices into high- and low-performing groups. Allowed amounts in claim data were used to calculate total and diabetes-related costs, including emergency room and hospital utilization. Participants included diabetic patients who had office visits to 44 ranked PCP practices from April 2019 to March 2020, for a total of 19,059 clinic visits. We also analyzed costs related to diabetic patients having Highmark Health insurance plans in the same period, for a total of 3,170 patients. The main measures included management practices that lead to better diabetes outcomes and costs associated with outcomes.Results Comparing 10,834 visits in high-performing practice to 8,235 visits in low-performing practice, referrals to certified diabetes care and education specialists and provider-to-provider electronic consults (e-consults) were higher in high-performing practices (Z = 6.06, p < .0001), while traditional referrals were higher in low-performing practices (Z = -6.94, p < .0001). The patient-to-provider ratio was higher in the low-performing group (M = 235.23) than in the high-performing group (M = 153.26) (Z = -2.82, p = .0048). Claims data analysis included 1,787 and 1,383 patients from high- and low-performing providers, respectively. The patient-to-provider ratio was higher in the low-performing group (p = .009, V = 0.62). Patients receiving care from lower-performing practices were more likely to have had a diabetes-related hospital observation (5.8% vs. 4.1%, p = .02; V = .04) and higher diabetes-related care costs (p = .002; d = − .07), but after controlling for patients’ characteristics, these differences were not significant (p = .14). Patients seeing low-performing providers had higher Charlson Comorbidity Index scores (Mdn = 3) than those seeing high-performing providers (Mdn = 2).Conclusions Referrals to the CDCES and e-Consult were associated with better measured diabetes outcomes, but without significant cost or hospital utilization differences.