Impact of Medicare beneficiaries enrollment in chronic care management services program on healthcare utilization and expenditures
Document Type
Event
Abstract
Background: The Centers for Medicare & Medicaid Services (CMS) estimates one in four adults have two or more chronic conditions. In 2015, CMS began covering Chronic Care Management services (CCM) for Medicare beneficiaries with two or more chronic conditions. Objectives: A review of Chronic Care Management (CCM) literature found multiple studies noting the positive financial impact of CCM programs. The purpose of this study is to examine healthcare expenditures and emergency department visits by patient enrollment in a CCM program in South Carolina. Presentation attendees will gain an understanding of CCM programs and the impact of these programs for medically vulnerable populations. Methods: Two Rural Health Clinics and Federally Qualified Health Centers were recruited to participate. Each office was provided funding to support HL7 data feeds to allow the bidirectional sharing of data with a CCM service provider. The CCM provider worked to enroll and serve patients eligible for CCM services. Patient enrollment was optional. The average healthcare expenditures by patient (eligible) enrollment in a CCM program (yes/no) (2) Emergency department (ED) visit variation by patient (eligible) enrollment in a CCM program (yes/no) were analyzed. Results: Expenditure and utilization data for patients 65 and older with two or more chronic conditions eligible for CCM services revealed CCM program enrollees had a greater claims total than eligible patients not enrolled in the CCM program. Non-CCM patients had more than double the average emergency department expenditures. Conclusion: Earlier studies have noted reductions in monthly expenditures for Medicare beneficiaries participating in CCM programs. Program guidelines have shifted in the six years since Medicare began reimbursing for the services. The results of this study align with previous research demonstrating variation of healthcare expenditures by patient enrollment in a CCM program with those enrolled having greater expenditures for some services. Those enrolled have lower ED utilization. Public health implications: Healthcare systems are shifting from a traditional sick-based reactive model to a preventative care approach. CCM service providers aid physician practices by providing their patients with a dedicated team of CCM specialists available to their patients 24 hours a day seven days a week. These specialists provide a focused preventative approach in tandem with the patient’s providers. The results of this research will be informative for both policymakers and care providers alike. Research was funded by the non-profit: South Carolina Research Authority (SCRA) – Academia Collaboration Team (SACT) Feasibility Grant.
Impact of Medicare beneficiaries enrollment in chronic care management services program on healthcare utilization and expenditures
Breakout Session A: Health Sciences I
CASB 101Background: The Centers for Medicare & Medicaid Services (CMS) estimates one in four adults have two or more chronic conditions. In 2015, CMS began covering Chronic Care Management services (CCM) for Medicare beneficiaries with two or more chronic conditions. Objectives: A review of Chronic Care Management (CCM) literature found multiple studies noting the positive financial impact of CCM programs. The purpose of this study is to examine healthcare expenditures and emergency department visits by patient enrollment in a CCM program in South Carolina. Presentation attendees will gain an understanding of CCM programs and the impact of these programs for medically vulnerable populations. Methods: Two Rural Health Clinics and Federally Qualified Health Centers were recruited to participate. Each office was provided funding to support HL7 data feeds to allow the bidirectional sharing of data with a CCM service provider. The CCM provider worked to enroll and serve patients eligible for CCM services. Patient enrollment was optional. The average healthcare expenditures by patient (eligible) enrollment in a CCM program (yes/no) (2) Emergency department (ED) visit variation by patient (eligible) enrollment in a CCM program (yes/no) were analyzed. Results: Expenditure and utilization data for patients 65 and older with two or more chronic conditions eligible for CCM services revealed CCM program enrollees had a greater claims total than eligible patients not enrolled in the CCM program. Non-CCM patients had more than double the average emergency department expenditures. Conclusion: Earlier studies have noted reductions in monthly expenditures for Medicare beneficiaries participating in CCM programs. Program guidelines have shifted in the six years since Medicare began reimbursing for the services. The results of this study align with previous research demonstrating variation of healthcare expenditures by patient enrollment in a CCM program with those enrolled having greater expenditures for some services. Those enrolled have lower ED utilization. Public health implications: Healthcare systems are shifting from a traditional sick-based reactive model to a preventative care approach. CCM service providers aid physician practices by providing their patients with a dedicated team of CCM specialists available to their patients 24 hours a day seven days a week. These specialists provide a focused preventative approach in tandem with the patient’s providers. The results of this research will be informative for both policymakers and care providers alike. Research was funded by the non-profit: South Carolina Research Authority (SCRA) – Academia Collaboration Team (SACT) Feasibility Grant.