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How to identify and support emerging risk Medi-Cal members with complex social and behavioral needs: a diabetes case study
How to identify and support emerging risk Medi-Cal members with complex social and behavioral needs: a diabetes case study
- Collection:
- Health Policy and Services Research
- Author(s):
- Parchman, Michael, author
Stefanik-Guizlo, Kelsey, author
Shah, Avni C., author
Glaseroff, Alan, author
Holden, Erika, author
Bertko, John, author
Zúñiga, Ramiro, author - Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, December 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Behavioral Medicine
Delivery of Health Care
Diabetes Mellitus
Government Programs
Health Equity
Healthcare Disparities
Medicaid
Mental Health Services
Social Support
State Health Plans
California - Genre(s):
- Technical Report
- Abstract:
- A significant number of Medi-Cal enrollees with diabetes have complex, unmet medical, behavioral, and social health needs that impact their health. Medi-Cal health plans, health systems, and providers are increasingly focused on meeting these needs. Here the authors report on a partnership between a nonprofit organization, a Medi-Cal managed care plan, and a Federally Qualified Health Center that shows promise. Health care systems, payers, and providers in California are increasingly focused on finding better ways to meet interconnected, complex patient needs to improve outcomes and address equity. California currently ranks 45th nationally for prevention and treatment services in The Commonwealth Fund’s 2023 Scorecard on State Health System Performance. California is 48th for the percentage of people with diabetes who had an annual HbA1c test, which measures blood sugar control over the past three months. The state has consistently ranked near the bottom for these indicators since 2019 and has not ranked above the bottom third for prevention and treatment services since 2009. In 2021, 37.5% of enrollees with diabetes in managed care plans under Medi-Cal, the state Medicaid program, had an HbA1c >9% (indicating poorly controlled diabetes and a higher risk of complications) - an increase from 34.2% in 2019. It is not uncommon to see a failure to intensify diabetes treatment in this population for a variety of reasons, such as provider lack of time and resources during a visit, or patient reluctance to change treatments due to lack of trust or fear of insulin. Although the American Diabetes Association recommends treatment intensification in those with type 2 diabetes every three to six months, treatment is intensified in only 31% of people living with type 2 diabetes for whom it is indicated, and the mean time to treatment intensification is 3.7 years. In addition, persistent inequities in diabetes control exist based on age, race, ethnicity, and income. For example, non-Hispanic Black people with type 1 diabetes experience higher rates of acute complications like diabetic ketoacidosis (DKA) and severe hypoglycemia that may result in hospitalization or death despite the existence of continuous glucose monitoring technology that can help reduce the occurrence of such events and is the standard of care for people with diabetes who use insulin. Additionally, Latinos/x in the United States have a 66% greater risk of developing type 2 diabetes and, once diagnosed, receive less care overall and exhibit worse outcomes than non-Hispanic White people.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (17 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918734177806676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918734177806676