Association of a Chronic Care Management Model with Health Care Costs and Utilization.

BACKGROUND

Chronic Care Management (CCM) programs aim to reduce avoidable acute care utilization through improved care coordination, but evidence regarding their effectiveness among high-risk patients remains mixed.

OBJECTIVE

To evaluate the association of a comprehensive CCM program delivered through a Care Transformation Organization (CTO) with acute care utilization and acute care expenditures.

DESIGN

Observational pre-post study with a concurrent comparison group and propensity-score-matched analysis.

PARTICIPANTS

High-risk patients attributed to Maryland Primary Care Program (MDPCP) primary care practices supported by the Johns Hopkins CTO between December 2021 and January 2024 who engaged in CCM (n = 1219) or were randomly sampled from non-engaged patients (n = 2438).

INTERVENTIONS: Multidisciplinary CCM delivered through the Johns Hopkins CTO, with registered nurse care managers supported by pharmacy, behavioral health, and community health worker services as clinically indicated.

MAIN MEASURES: Acute hospitalizations, emergency department (ED) visits, 30-day readmissions, and associated acute care expenditures during the 6 months before and after the index date.

KEY

RESULTS

Among 3657 patients, CCM participants had substantially higher baseline acute care utilization than non-engaged patients. In unmatched analyses, CCM was associated with relative reductions in hospitalizations (54%; incidence rate ratio [IRR], 0.46; 95% CI, 0.35-0.62) and ED visits (33%; IRR, 0.67; 95% CI, 0.52-0.85) compared with controls, without a significant difference in readmissions. In the propensity-score-matched cohort (n = 2370), CCM was associated with greater reductions in hospitalizations (average treatment effect on the treated [ATT], - 0.22; 95% CI, - 0.29 to - 0.16) and ED visits (ATT, - 0.20; 95% CI, - 0.28 to - 0.13), but not readmissions (ATT, 0.00; 95% CI, - 0.03 to 0.03). Acute care expenditures were $3008 lower among CCM participants in the matched analysis.

CONCLUSIONS

Among high-risk patients attributed to MDPCP practices supported by the Johns Hopkins CTO, CCM engagement was associated with reductions in hospital and ED utilization and associated acute care expenditures.