2037-P: Diabetes-Related Clinical Quality Performance of Value-Based Payment Models for Medicare Advantage Members

Introduction and Objective: Value-based payment (VBP) incentivizes evidence-based, coordinated, patient-centered primary care. The objective of this study was to compare diabetes-related clinical quality between VBP and non-VBP models, and across provider-payor risk sharing levels, for Medicare Advantage. Methods: Differences in clinical quality scores (2023 CMS Star Ratings, %) between payment models (VBP, non-VBP) and across risk sharing levels (2-sided, 1-sided, pay-for-performance [P4P], non-VBP) were evaluated in this retrospective cohort study. Outcome measures included statin use in persons with diabetes (SUPD), medication adherence for diabetes medications (MAD), and blood sugar controlled (HBD). Propensity score matching and weighting were used to balance member covariates. Generalized linear model analyses with Bonferroni correction and post-hoc Tukey tests examined group differences. Mean (standard error) reported unless otherwise noted. Results: There were 3,228,872 members (56.5% female; mean [standard deviation], 72.4 [9.2] years) who met inclusion criteria. For all measures, VBP outperformed non-VBP: +1.7 (0.1)% for SUPD, +1.7 (0.1)% for MAD, and +24.1 (0.2)% for HBD (all P<.001). Two-sided risk outperformed 1-sided risk, and 1-sided risk outperformed P4P for SUPD (+1.7 [0.2]%, +1.0 [0.2]%) and MAD (+0.1 [0.2]%, +0.9 [0.2]%) (all P<.001). HBD scores improved as risk sharing increased (i.e., 2-sided>1-sided>P4P>non-VBP; range: +3.3 [0.2]% to +15.4 [0.2]%; all P<.001). Conclusion: Clinical quality for diabetes management was better in VBP models than non-VBP. VBP models with more provider risk generally had better clinical quality performance than models with less or no provider risk. Notably, HBD had the greatest improvement from non-VBP to VBP arrangements and demonstrated incremental improvements in clinical quality performance as risk sharing increased. Findings from this study support risk sharing as a lever for advancing diabetes-related health care quality. Disclosure E.M. Beltz: Employee; Current; CVS Health. Stock/Shareholder; Current; CVS Health. W. Xin: Employee; Ended; CVS Health. A. Zaleski: Employee; Current; CVS Health. Stock/Shareholder; Current; CVS Health. E. Pegler: Employee; Current; CVS Health. Stock/Shareholder; Current; CVS Health. K.J. Craig: Employee; Current; CVS Health.