A Data-Driven Pediatric Type 1 Diabetes Population Health Model Within Specialty Value-Based Care

Pediatric 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.

Descriptive 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.

From 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.

Pairing 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.