{
  "abstract": "ObjectivePediatric specialty value-based care (VBC) for chronic conditions remains under-described. We describe the design and early performance of a data-driven population health model for pediatric type 1 diabetes within a specialty VBC program.\n\nResearch Design and MethodsDescriptive evaluation at a single academic pediatric medical center and clinically integrated network, 2021-2025, with formal VBC operation beginning in 2024. Participants were children and adolescents with type 1 diabetes attributed through commercial and Medicaid value-based agreements (n=786 in 2025). The program paired infrastructure funding with performance-dependent payments tied to clinical quality and utilization measures, supported by remote monitoring and care management. Measures: percentage receiving the chronic care intervention, population median HbA1c, percentage with HbA1c >9% (75 mmol/mol), percentage with [≥]1 diabetic ketoacidosis (DKA) admission, and inpatient and emergency department (ED) visit rates per 1,000/month.\n\nResultsFrom 2021 to 2025, median HbA1c decreased from 8.6% (70 mmol/mol) to 7.9% (63 mmol/mol), HbA1c >9% (75 mmol/mol) decreased from 41.1% to 27.6%, and [≥]1 DKA admission decreased from 9.1% to 5.6%. Inpatient admissions per 1,000/month decreased from 11.2 to 7.4 and ED visits from 10.0 to 7.6. The program met 3 of 6 targets in 2024 and all 6 in 2025.\n\nConclusionsPairing infrastructure funding with performance-dependent payments was feasible and associated with sustained improvements in glycemic control and reduced acute care utilization. Further multi-site evaluation is needed to determine impact, generalizability, and sustainability.\n\nGraphical Abstract\n\nO_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=145 SRC=\"FIGDIR/small/26365944v1_ufig1.gif\" ALT=\"Figure 1\"> View larger version (59K): org.highwire.dtl.DTLVardef@686c5eorg.highwire.dtl.DTLVardef@1a2a618org.highwire.dtl.DTLVardef@146b111org.highwire.dtl.DTLVardef@130e37_HPS_FORMAT_FIGEXP M_FIG C_FIG",
  "abstract_shown": true,
  "affiliations": [
    "Lurie Children's Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "name": "D. R. Pahud"
    },
    {
      "name": "L. A. Harris"
    },
    {
      "name": "B. Lockee"
    },
    {
      "name": "K. E. Noland"
    },
    {
      "name": "J. Redel"
    },
    {
      "name": "D. R. Tilden"
    },
    {
      "name": "K. Diederich"
    },
    {
      "name": "R. Moran"
    },
    {
      "name": "M. A. Clements"
    },
    {
      "affs": [
        0
      ],
      "name": "J. C. Espinoza"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ehybzjstdsjsx.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.21.26365944",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.21.26365944v1.full",
  "id": "ehybzjstdsjsx",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.21.26365944v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "endocrinology"
    ],
    [
      "openalex",
      "2712|Diabetes Management and Research"
    ]
  ],
  "openalex": "W7223364551",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.21.26365944v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ehybzjstdsjsx.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:34Z",
      "native_id": "10.64898/2026.10.21.26365944",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.21.26365944v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:endocrinology",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "A Data-Driven Pediatric Type 1 Diabetes Population Health Model Within Specialty Value-Based Care",
  "title_text": "A Data-Driven Pediatric Type 1 Diabetes Population Health Model Within Specialty Value-Based Care",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:34Z",
  "url": "https://research.draconitic.com/paper/ehybzjstdsjsx",
  "venue": "medRxiv",
  "versions": []
}