Diabetes is a major contributor to rising healthcare costs in the US, affecting over 30 million Americans. As the healthcare system shifts from fee-for-service to value-based care, Accountable Care Organizations (ACOs) are well-positioned to address the complexities of diabetes prevention, treatment, and management. ACOs focus on wellness, population health management, and value across the continuum of care. They are evaluated on quality measures related to diabetes that cover prevention, treatment, and management. Their coordinated care model and focus on quality make them suited to improving diabetes outcomes while reducing unnecessary costs.

1. DIABETES
& ACOS
BY TXCIN
A VALUE-BASED
CARE STRATEGY

2. In today’s healthcare system,
diabetes, and treatment associated
with the disease, continues to be a
major contributor to rising
healthcare costs. Diabetes remains
the 7th leading cause of death in
the United States, affecting 30.3
million Americans in 2015, or 9.4%
of the U.S. population.

3. As the healthcare environment
shifts from traditional fee-for-
service (FFS) to value-based
care, Accountable Care
Organizations (ACOs) are
positioned to play an influential
role in successfully addressing
the complexities of diabetes
prevention, treatment, and
management.

4. The traditional healthcare
system is built upon the fee-for-
service, or quantity-over-quality,
reimbursement framework,
where physicians are paid solely
on services provided, and where
limited coordination exists
between specialties. Often
patients are left to navigate
through the healthcare system
alone, which can be confusing,
frustrating, and overwhelming,
especially for patients who are
dealing with the physical and
emotional challenges of a
chronic disease.
TRADITIONAL
HEALTHCARE
APPROACH

5. In the value-based care
environment, clinicians
intentionally consider the quality
of care provided, and the overall
outcomes of that care, in relation
to cost-efficiency. Physicians and
specialists consider “best
practices” when treating
patients, since they are
reimbursed for the quality and
efficiency of care they provide. In
other words, value-based care
emphasizes more proactive,
patient-centered, coordinated,
and efficient care, predicated on
quality performance.
VALUE-
BASED CARE
APPROACH

6. ACO STRATEGY FOR
DIABETES CARE
Accountable Care Organizations are at the
forefront of the value-based care movement.
ACOs are voluntary networks of physicians,
specialists, surgeons, clinics, care coordinators
and educators, dieticians, nursing homes,
pharmacies, and hospitals who agree to
coordinate care for a patient population, with the
goal of improving quality care, while eliminating
unnecessary spending. In short, ACOs focus on
wellness and prevention, population health
management, and value across the continuum of
care.

7. ACO STRATEGY FOR
DIABETES CARE
Studies project that 1 in 3 people will develop type 2
diabetes by 2050, placing them at high risk for
developing serious health complications, including
cardiovascular disease, stroke, blindness, kidney
disease and kidney failure, heart disease, and non-
traumatic lower-limb amputations. Diabetes
patients can require an enormous amount of care,
leading to expensive healthcare costs, 2.3x greater
than patients without diabetes; however, with their
strategic, coordinated-care emphasis and reach, and
their focus on quality performance, ACOs are
distinctively suited to address the complexities of
diabetes care.

8. For example, under the Quality
Payment Program (QPP), ACOs
are graded on 31 quality
measures (29 individual
measures and one composite
that includes two individual
component measures)
spanning four quality domains:

9. C
A
O
Patient / Caregiver
Experience
Care Coordination /
Patient Safety
Preventive Health
Clinical Care for At-
Risk PopulationsS

10. Diabetes related performance measures exist
in all four quality domains, collectively
covering approximately 75% of the required
quality performance measures. This focus
underscores how diabetes and its related
complications are a significant concentration
of healthcare resources in the U.S. and how
there is an increased intentionality by CMS to
focus on quality care and efficiency in diabetes
prevention, treatment, and management.
http://www.insight-txcin.org/post/diabetes-and-
accountable-care-organizations-a-value-based-care-strategy

11. Want
More?
http://www.insight-
txcin.org/post/diabetes-and-
accountable-care-
organizations-a-value-
based-care-strategy

12. ABOUT
TXCIN
North Texas Clinically
Integrated Network, Inc. (dba
TXCIN) is a non-profit ACO
that began in late 2014. A
small group of independent
physicians aligned to initiate
clinical integration and value-
based contracting. Partnering
with RevelationMD and its
state-of-the art information
platform, TXCIN has become
the largest independent
network of physicians in North
Texas.