Overlap between transitional care management after hospital discharge and alternative payment models

Area of Science:

• Health Services Research
• Health Policy
• Health Disparities

Background:

• Effective care coordination is crucial for successful posthospital transitions.
• The Centers for Medicare & Medicaid Services (CMS) promotes care coordination via alternative payment models (APMs) and transitional care management (TCM) services.
• Limited data exist on the overlap and characteristics of beneficiaries within APM and TCM programs.

Purpose of the Study:

• To compare the characteristics of beneficiaries in APM-aligned and TCM groups.
• To quantify the overlap between APM-aligned discharges and those involving TCM services.
• To identify potential health disparities related to the intersection of APMs and TCM.

Main Methods:

• Analysis of 2018-2019 Medicare claims data for over 7 million beneficiaries and 11 million discharges.
• Comparison of beneficiary characteristics across APM-aligned and TCM groups.
• Quantification of the overlap between APM-aligned discharges and TCM utilization.

Main Results:

• 41.6% of discharges were APM-aligned, and 14.5% involved TCM.
• TCM services were utilized in 19.7% of APM-aligned discharges.
• 56.7% of TCM services were provided to APM-aligned beneficiaries, who were less likely to be from underserved populations compared to non-APM beneficiaries.

Conclusions:

• Significant overlap exists between APMs and TCM services within Medicare.
• APM-aligned beneficiaries receiving TCM may represent a less diverse population, indicating potential health disparity concerns.
• Further research is needed to understand the impact of this overlap on care coordination and patient outcomes.