The Diabetes Health Plan and Healthcare Utilization Among Beneficiaries with Low Incomes

Abstract

Background: The socioeconomic status (SES) gradient in hospital and emergency room utilization among adults with type 2 diabetes (T2DM) is partially driven by cost-related non-adherence. Objective: To test the impact of the Diabetes Health Plan (DHP), a diabetes-specific health plan incorporating value-based insurance design principles on healthcare utilization among low-income adults with T2DM. Design: To examine the impact of the DHP on healthcare utilization, we employed a difference-in-differences (DID) study design with a propensity-matched comparison group. We modeled count and dichotomous outcomes using Poisson and logit models, respectively. Participants: Cohort of adults (18–64) with T2DM, with an annual household income < 0.001), on average, than comparison beneficiaries. Models for emergency room (0.00 [95% CI: − 0.06, 0.06], p = 0.966) and hospital utilization (− 0.03 [95% CI: − 0.08, − 0.01], p = 0.164) did not demonstrate statistically significant changes associated with DHP exposure. Conclusions: While no relationship between DHP exposure and high-cost utilization was observed in the short term, fewer in-person disease management visits were observed. Future studies are needed to determine the clinical implications of these findings.