Impact of a primary care provider tele-mentoring and community health worker intervention on utilization in Medicaid patients with diabetes

Authors

Saul Blecker, Department of Population Health, NYU School of Medicine, New York, New York; Department of Medicine, NYU School of Medicine, New York, New York
Emil Lemieux, Flatiron Health, Inc, New York, New York
Margaret M. Paul, Department of Population Health, NYU School of Medicine, New York, New York
Carolyn A. Berry, Department of Population Health, NYU School of Medicine, New York, New York
Matthew F. Bouchonville, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
Sanjeev Arora, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
John Billings, Wagner School of Public Service, New York University, New York, New York

Document Type

Article

Publication Date

2020

Abstract

Objective: The Endocrinology ECHO intervention utilized a tele-mentoring model that connects primary care providers (PCPs) and community health workers (CHWs) with specialists for training in diabetes care. We evaluated the impact of the Endo ECHO intervention on healthcare utilization and care for Medicaid patients with diabetes in New Mexico.
Methods: Between January 2015 and April 2017, patients with complex diabetes from 10 health centers in NM were recruited to receive diabetes care from a PCP and CHW upskilled through Endo ECHO. We matched intervention patients in the NM Medicaid claims database to comparison Medicaid beneficiaries using 5:1 propensity matching. We used a difference-in-difference (DID) approach to compare utilization and processes of care between intervention and comparison patients.
Results: Of 541 Medicaid patients enrolled in Endo ECHO, 305 met inclusion criteria and were successfully matched. Outpatient visits increased with Endo ECHO for intervention patients as compared to comparison patients (rate ratio, 1.57; 95% confidence interval [CI], 1.43 to 1.72). The intervention was associated with an increase in emergency department (ED) visits (rate ratio, 1.30; 95% CI, 1.04 to 1.63) but no change in hospitalizations (rate ratio, 1.47; 95% CI, 0.95 to 2.23). Among intervention patients, utilization of metformin increased from 57.1% to 60.7%, with a DID between groups of 8.8% (95% CI, 4.0% to 13.6%). We found similar increases in use of statins (DID, 8.5%; 95% CI, 3.2% to 13.8%), angiotensin-converting enzyme inhibitors (DID, 9.5%; 95% CI, 3.5% to 15.4%), or antidepressant therapies (DID, 9.4%; 95% CI, 1.1% to 18.1%).
Conclusion: Patient enrollment in Endo ECHO was associated with increased outpatient and ED utilization and increased uptake of prescription-related quality measures. No impact was observed on hospitalization.

Recommended Citation

Blecker, S., Lemieux, E., Paul, M. M., Berry, C. A., Bouchonville, M. F., Arora, S., & Billings, J. Impact of a primary care provider tele-mentoring and community health worker intervention on utilization in Medicaid patients with diabetes. Endocrine Practice. 2020; 26(10), 1070-1076. https://doi.org/10.4158/EP-2019-0535