Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes

Dongzhe Hong; Charles Stoecker; Yixue Shao; Elizabeth Nauman; Vivian Fonseca; Gang Hu; Alessandra N Bazzano; Edmond K Kabagambe; Lizheng Shi

doi:10.1007/s11606-024-08667-0

Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes

J Gen Intern Med. 2024 Feb 21. doi: 10.1007/s11606-024-08667-0. Online ahead of print.

Authors

Dongzhe Hong^{1

2

3}, Charles Stoecker¹, Yixue Shao¹, Elizabeth Nauman⁴, Vivian Fonseca⁵, Gang Hu⁶, Alessandra N Bazzano⁷, Edmond K Kabagambe^{8

9}, Lizheng Shi¹⁰

Affiliations

¹ Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
² Program On Regulation, Therapeutics, and LAW (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
³ Harvard Medical School, Boston, MA, USA.
⁴ Louisiana Public Health Institute, New Orleans, LA, USA.
⁵ Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA, USA.
⁶ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
⁷ Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
⁸ Division of Academics, Ochsner Center for Outcomes Research, Ochsner Health, New Orleans, LA, USA.
⁹ Penn Medicine Lancaster General Health, Lancaster, PA, USA.
¹⁰ Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. lshi1@tulane.edu.

PMID: 38381242
DOI: 10.1007/s11606-024-08667-0

Abstract

Background: Type 2 diabetes mellitus (T2DM) results in heavy economic and disease burdens in Louisiana. The Centers for Medicare and Medicaid Services has reimbursed non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions since 2015.

Objective: To assess the impacts of NFFCCM on healthcare utilization and health outcomes.

Design, setting, and participants: This retrospective cohort study included Medicare fee-for-service beneficiaries with T2DM and at least one additional chronic disease between 2014 and 2018.

Exposures: At least one record of NFFCCM Current Procedural Terminology codes.

Main measures: The health outcomes in the study included major adverse cardiovascular events (MACE), all-cause mortality, and heart failure. The monthly service utilization and continuity of care index for primary care were also included. The propensity score method was used to balance the baseline differences between the two groups. Weighted multivariate regression models were developed using propensity score weights to assess the impacts of NFFCCM on outcomes.

Key results: During the 5 years of study period, 8415 patients among the 118,643 Medicare beneficiaries received at least one NFFCCM. Patients receiving any NFFCCM had reduced healthcare utilization compared with patients not receiving NFFCCM, including 0.012 (95% CI - 0.014 to - 0.011; p < 0.001) fewer monthly hospital admissions, 0.017 (95% CI - 0.019 to - 0.016; p < 0.001) fewer monthly ED visits, and 0.399 (95% CI 0.375 to 0.423; p < 0.001) more monthly outpatient encounters. Patients receiving NFFCCM services had lower MACE event rates of 7.4% (95% CI 7.1 to 7.8%; p < 0.001), all-cause mortality rate of 7.8% (95% CI 7.4 to 8.1%; p < 0.001), and heart failure rate of 0.3% (95% CI 0.2 to 0.5%; p < 0.001), respectively.

Conclusions and relevance: These findings suggest that reimbursement for NFFCCM was associated with the shifting high-cost utilization to lower-cost primary health care settings among patients with diabetes in Louisiana.

Abstract

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