Summary
A medRxiv preprint describes a value-based care program for children and adolescents with type 1 diabetes at one US pediatric medical centre. From 2021 to 2025, reported HbA1c and acute-care measures improved, although the descriptive study cannot establish that the program caused the changes.
A medRxiv preprint reports that a value-based care program for children and adolescents with type 1 diabetes was associated with improved blood-glucose measures and fewer inpatient and emergency department visits between 2021 and 2025. The descriptive evaluation covered one academic pediatric medical centre and its clinically integrated network; formal operation of the value-based care program began in 2024.
How the care model was organised
The program combined infrastructure funding with payments that depended on performance against clinical quality and healthcare-use measures. Remote monitoring and care management supported the care model. The study included children and adolescents attributed to the program through commercial and Medicaid value-based agreements; the attributed population numbered 786 in 2025.
HbA1c is a blood test used to assess average glucose levels over roughly the preceding two to three months. Across the reported period, the population’s median HbA1c fell from 8.6% (70 mmol/mol) in 2021 to 7.9% (63 mmol/mol) in 2025. The proportion with HbA1c above 9% (75 mmol/mol) declined from 41.1% to 27.6%.
Changes in acute-care measures
The proportion of participants with at least one diabetic ketoacidosis (DKA) admission fell from 9.1% in 2021 to 5.6% in 2025. DKA is a serious diabetes complication that can require urgent hospital treatment. Inpatient admissions per 1,000 participants per month declined from 11.2 to 7.4, while emergency department visits fell from 10.0 to 7.6 over the same period.
The program met three of its six performance targets in 2024 and all six in 2025. The results suggest that a specialty care program combining funding, monitoring and care management can track both clinical and utilisation outcomes within value-based agreements.
The study is a single-centre descriptive evaluation, not a controlled comparison. Because the reported outcome trends begin in 2021 and formal value-based care operation began in 2024, the full-period changes cannot be attributed to the payment model alone. The authors say multi-site evaluation is needed to assess impact, generalisability and sustainability.