Social Connectedness and the Impact of the CMS Accountable Health Communities Model on Racial Equity of Diabetes Care

Diabetes-related exacerbations are among the most common and expensive reasons for potentially preventable hospitalizations. Health-related social needs (HRSNs) such as housing, food, and support to pay for utilities impede diabetes care management and result in preventable hospitalizations due to diabetes- related exacerbations. Regional initiatives aimed at improving public health, social care, and health care system alignment and screening and referral for addressing HRSNs have high potential to improve diabetes care management, behavioral health, and reduce racial and ethnic disparities. From 2018-2022, the Centers for Medicare and Medicaid Services (CMS) supported the implementation of the Accountable Health Communities (AHC) Model in multiple geographic regions to strengthen clinic-community linkages and address HRSNs through resource navigation. We advance evidence by using a natural experiment of CMS AHC implementation in 13 geographic regions to estimate the impact of the AHC model on care management among adult Medicare, Medicaid, and dually-enrolled adult beneficiaries with type 2 diabetes and behavioral health (alcohol misuse, physical activity, and smoking). The project will identify how the AHC model impacted diabetes care management and behavioral health and how the social connectedness and area-level social determinants of health (SDoH) of AHC model regions impacted diabetes care management, behavioral health, and racial and ethnic disparities. A difference-in-differences (DiD) design will be used to account for time- invariant differences between counties with and without the AHC model. Propensity score methods will be paired with DiD regression models to account for differences in beneficiary characteristics that differ in the pre- AHC (January 1, 2012 to December 31, 2017) period and AHC implementation (January 1, 2018 to December 31, 2022) period. We hypothesize that the CMS AHC model (1) improved diabetes care management and behavioral health, (2) reduced racial and ethnic disparities in diabetes care management; and that (3) social connectedness and area-level SDoH will partially explain variation in the AHC model’s impact on diabetes care management and racial/ethnic disparities between geographic regions. The rationale for the proposed research is that, once it is known how the AHC model impacted diabetes care management and behavioral health, the evidence can inform future policies to support regional infrastructure and interorganizational collaboration to address HRSNs and diabetes-related disparities. Our long-term goal is to ensure that adults with type 2 diabetes receive coordinated, integrated care for their medical, behavioral, and social needs. Strengthening resource navigation and systems alignment can support the wellbeing of adults with type 2 diabetes. The proposed project has high potential to close evidence gaps about the impact of regional initiatives that aim to improve systems alignment, diabetes care management, and behavioral health.