Hemoglobin A1C is an essential blood test to diagnose and monitor diabetes and prediabetes. Guidelines recommend at least two A1C tests per year among diabetics.2 We sought to understand the variation of A1C test across accountable care organizations (ACOs) by looking at the average A1C test frequency in a single year, adjusted on age, gender, race and hcc score.
Among the 453 ACOs with more than 5000 attributed beneficiaries in 2017, the average prevalence of diabetes was around 23%. Overall, 82 (18%) of these ACOs have an average adjusted A1C test per diabetic beneficiary of less than 2 per year, suggesting possible underutilization of proper A1C tests to manage their diabetes population. Among the remaining ACOs, average adjusted A1C test range from 2 per year to 4.6 per year. We cannot know from ACO-level aggregated statistics what prompted such distinct care patterns and if or how they are associated with health outcomes. Zooming into the provider and beneficiary level A1C data from our study will help better assess the appropriateness of A1C tests within and across ACOs and identify predictors.
Lower Extremity Amputation
Among diabetes, lower extremity amputation (LEA) is an indicator of poor long-term diabetic care management. LEA in the diabetic population can cost between $30,000 and $60,000 annually and accumulate up to half a million USD in one’s lifetime.3 Across the same 453 ACOs identified previously, we found that, on average, about 0.49% of diabetic beneficiaries had LEA. The range of average LEA rate goes from 0% to as high as 2.5% across the ACOs.
Further, we examined variation in rates of other recommended diabetes care, including annual eye exams, annual nephropathy testing, and lipid testing. In addition, we evaluated measures associated with diabetes care management, including avoidable emergency room visits, length of stay (LOS) in acute care hospitals, annual wellness visits and evaluation & management (E&M) visits with various specialties, e.g., primary care physicians, endocrinologists, ophthalmologists, nurse practitioners/physician assistants and all other specialties. Combined with different demographic, condition-based and geographic cuts, these data points will allow our users to draw actionable insights on their diabetic populations and regions, informing interventions aimed at achieving better diabetic care management and patient outcome in the long-run.
If you are interested in learning more about our findings related to the Medicare FFS diabetic population, please feel free to reach out to your Member Services representative or contact us at [email protected].