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Significant Variation in Clinical Quality, Cost for Californians with Diabetes in Commercial Market

An Atlas data brief, produced by the nonprofit Integrated Healthcare Association, found significant variation in clinical quality and cost of care for Californians with diabetes in the commercial market. Analysis of Atlas 2017 results for four measures of clinical quality related to diabetes screening and management at the level of the Covered California region shows enormous variation in clinical quality results across California regions, even for a commercially insured population.

The Atlas is a benchmarking and hot-spotting improvement tool that includes results and information on about 30 million insured Californians. For commercial insurance, the Atlas tracks regional performance for clinical quality, average annual total cost of care per member, and hospital utilization, based on the care provided to roughly 14 million Californians enrolled in health maintenance organizations (HMOs), preferred provider organizations (PPOs), Accountable Care Organizations (ACOs), and self-insured arrangements.

Key Findings include:

  • There is wide geographic variation in clinical quality measures for diabetes care; only 25% of individuals with diabetes have blood sugar under control in the lowest-scoring region
  • Geography-adjusted total cost of care for individuals with diabetes is, on average, almost three times as high as for the overall commercial population statewide ($13,785 vs. $4,781)
  • At the regional level, average geography-adjusted total cost of care for individuals with diabetes ranges from $12,000 to over $18,000
  • Better results were observed on clinical quality for members with diabetes receiving care from providers taking financial risk (professional or full)
  • Better blood sugar control was associated with lower ED utilization

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