Summary
Because value-based care is critical to the Affordable Care Act success, the authors forecasted inpatient costs and the potential impact of podiatric medical care on savings in the diabetic population through improved care quality and decreased resource use during implementation of the health reform initiatives in California, by using enrollment of diabetic adults into Medicaid and subsidized health benefit exchange programs using the California Simulation of Insurance Markets (CalSIM) base model. Amputations and admissions per 1,000 diabetic patients and inpatient costs were based on the California Office of Statewide Health Planning and Development 2009-2011 inpatient discharge files. Cost was evaluated in three categories: uncomplicated admissions, amputations during admissions, and discharges to a skilled nursing facility. Total costs and projected savings were calculated by applying the metrics and cost to the projected enrollment.
Findings: Diabetic patients accounted for 6.6 percent of those newly eligible for Medicaid or health benefit exchange subsidies, with a 60.8-percent take-up rate. The authors project costs to be $24.2 million in the diabetic take-up population from 2014 to 2019. Inpatient costs were 94.3 percent higher when amputations occurred during the admission and 46.7 percent higher when discharged to a skilled nursing facility. Meanwhile, 61.0 percent of costs were attributed to uncomplicated admissions. Podiatric medical services saved 4.1 percent with a 10-percent reduction in admissions and amputations and an additional 1 percent for every 10-percent improvement in access to podiatric medical care. Conclusions: When implementing the Affordable Care Act, inclusion of podiatric medical services on multidisciplinary teams and in chronic-care models featuring prevention helps shift care to ambulatory settings to realize the greatest cost savings.
