A Medicaid health home care management program led to improved diabetes care, with significant benefits for people with co-occurring substance use disorders and diabetes.
Patients with diabetes have a high prevalence of substance use disorder (SUD). While high-quality care can help prevent diabetes-related complications such as end-stage renal disease, many individuals with co-occurring SUD may receive poorly coordinated care across their physical and behavioral health conditions. The New York State Health Home program for Medicaid enrollees included comprehensive care management to increase access to treatment. This study evaluated process outcomes for diabetes care before and after enrollment in the health home, as compared to a matched comparison group who did not enroll in the health home, including an evaluation of improvements among individuals with co-occurring diabetes and SUD.
While all health home participants with diabetes experienced modest improvements in process outcomes for diabetes care such as increases in HbA1c tests, eye exams, and medical attention for kidney disease, participants with co-occurring SUD experienced more substantial improvements. The percentage of individuals who received all three services increased for all health home participants with diabetes, but this increase was statistically significant and substantially higher for those with co-occurring SUD.
A whole person approach to care management, as implemented in a state health home, can lead to improved outcomes in diabetes care, especially for individuals with co-occurring SUD. Care management programs can help support access to treatment and reduced costs of care for individuals with co-occurring physical and behavioral health conditions.