Medicare patients who participate in the Center for Medicare and Medicaid Innovation's chronic care management program are more likely to stay out of the hospital – and have lower growth in their Medicare costs — because they have connected with community-based resources, according to CMMI's report, "Evaluation of the Diffusion and Impact of the Chronic Care Management Services."
The Centers for Medicare and Medicaid Services launched the chronic care management program in 2015 to help provide support for patients with multiple chronic conditions between the times they visit their health care provider. The program comes with a new Medicare-benefit that provides "in-between visit" revenue to participating providers – intended to enhance their focus on goal-directed, person-centered care planning, and to provide "aging-in-place" resources such as proactive care management.
The study showed that patients in the CCM program had lower hospital, emergency department and skilled nursing facility costs compared than the comparison group, resulting in a lower growth in total costs to Medicare.
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Receipt of CCM services was also associated with a reduced likelihood of hospital admission for the ambulatory care sensitive conditions of diabetes, congestive heart failure, urinary tract infection and pneumonia among CCM beneficiaries, relative to the comparison beneficiaries. The CCM program was also associated with increased access to advance care planning – 10 percent among CCM participants, compared to 1 percent in the general Medicare population. The study authors conclude that "CCM is having a positive effect on lowering the growth in Medicare expenditures on those that received CCM services."
"The CMMI study performed by Mathematica showed a significant early chronic care management program success," says Dr. William Mills, president and CEO of Chronic Care Management, Inc.
Most notably, patients in the CCM program were more connected to their healthcare providers, had more access to their primary care doctor and better utilized home-based services like home health care, "which are helping patients avoid unnecessary hospital and emergency department use," Mills says.
"This study also showed reduced hospitalizations for ambulatory care sensitive conditions among CCM beneficiaries, which is a major focus of the program – to help empower patients and providers with actionable plans that can help keep patients at home, instead of in hospitals," he says.
Many beneficiaries felt that participating in CCM services had provided them with more timely access to their CCM practice. Beneficiaries appreciated having ready access to a nurse or care manager who could communicate with the physician or schedule an appointment more quickly than the patient could have.
As one beneficiary explained, "I felt like I had an in to the doctor, like there was somebody else to help me through that process [rather] than just calling the main number and then you wait on hold and then they have to type it in the computer and then they have to get it to the doctor."
Another beneficiary described how prompt attention from her primary care office helped prevent a potentially dangerous drug interaction, "When I had a blood test, my iron was low, so the doctor said that I should go to the drugstore and buy some iron medicine. (…) I was just looking at it one day and it said on there do not take iron medicine with the thyroid medicine, that it could have serious repercussions. I called (the nurse) and asked her… Within five minutes, she had talked to the doctor and he had given her different instructions and she relayed it to me and we changed the medicine and it was all done like in 15 minutes."
Beneficiaries generally appreciated the monthly check-ins and described them as "reassuring" and "a good reminder." One beneficiary described how the monthly phone calls helped him and his wife, who was also receiving CCM services, to remain mindful of their health, "We think about our health more and what we're doing right or wrong with these phone calls that we're getting every month now. It's a good thing."
Another beneficiary described how having more regular communication with his provider influenced him to continue taking his medications despite some undesirable side effects, "For one thing, I think I'm more conscious of taking my medication. …Being in constant contact with him, you begin to realize, look, yes, it's going to have some side effects here and there, but its doing what it's supposed to do."
Many beneficiaries felt CCM services were beneficial and planned to continue participating. One beneficiary said he would continue to participate "until my heart stops beating."
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
