A Data-Driven Pediatric Type 1 Diabetes Population Health Model Within Specialty Value-Based Care
- 1Lurie Children's Hospital
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.
Research 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.
ResultsFrom 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.
ConclusionsPairing 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.
Graphical Abstract
O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=145 SRC="FIGDIR/small/26365944v1_ufig1.gif" ALT="Figure 1"> View larger version (59K): [email protected]@1a2a618org.highwire.dtl.DTLVardef@146b111org.highwire.dtl.DTLVardef@130e37_HPS_FORMAT_FIGEXP M_FIG C_FIG
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BibTeX
@misc{pahud2026datadriven,
title = {{A Data-Driven Pediatric Type 1 Diabetes Population Health Model Within Specialty Value-Based Care}},
author = {D. R. Pahud and L. A. Harris and B. Lockee and K. E. Noland and J. Redel and D. R. Tilden and K. Diederich and R. Moran and M. A. Clements and J. C. Espinoza},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.21.26365944},
url = {https://www.medrxiv.org/content/10.64898/2026.10.21.26365944v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - A Data-Driven Pediatric Type 1 Diabetes Population Health Model Within Specialty Value-Based Care
AU - D. R. Pahud
AU - L. A. Harris
AU - B. Lockee
AU - K. E. Noland
AU - J. Redel
AU - D. R. Tilden
AU - K. Diederich
AU - R. Moran
AU - M. A. Clements
AU - J. C. Espinoza
PY - 2026
DA - 2026/10/21
PB - medRxiv
DO - 10.64898/2026.10.21.26365944
UR - https://www.medrxiv.org/content/10.64898/2026.10.21.26365944v1
AB - 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. Research 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. ResultsFrom 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. ConclusionsPairing 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. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=145 SRC="FIGDIR/small/26365944v1_ufig1.gif" ALT="Figure 1"> View larger version (59K): [email protected]@1a2a618org.highwire.dtl.DTLVardef@146b111org.highwire.dtl.DTLVardef@130e37_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -