Chronic Care Management and Mortality Among Diabetic Patients with Multiple Chronic Conditions

Area of Science:

• Health Services Research
• Gerontology
• Public Health

Background:

• The Centers for Medicare and Medicaid Services introduced reimbursement for chronic care management (CCM) in 2015.
• Patients with multiple chronic conditions, particularly diabetes, represent a significant and growing population within Medicare.
• Understanding the utilization patterns and impact of CCM services is crucial for improving care for these beneficiaries.

Purpose of the Study:

• To analyze factors associated with the initiation of CCM services among Medicare beneficiaries with diabetes and other chronic conditions.
• To assess the risk of mortality following the initiation of CCM services.
• To identify barriers and facilitators to CCM adoption in a Medicare population.

Main Methods:

• Retrospective cohort study utilizing Medicare claims data from 2015-2020 in Illinois, Iowa, Minnesota, and Wisconsin.
• Analysis of 885,132 beneficiaries diagnosed with diabetes and at least one other chronic condition.
• Competing-risk and Cox proportional hazard models were employed to analyze CCM initiation and mortality risk, respectively.

Main Results:

• Only 1.0% of eligible beneficiaries initiated CCM services.
• Factors associated with higher CCM initiation included older age, female sex, Black or Hispanic ethnicity, home or skilled nursing facility care, and post-2015 diabetes diagnosis.
• Patients in non-urban areas were less likely to receive CCM; no significant difference in mortality was observed between CCM initiators and non-initiators.

Conclusions:

• CCM services remain significantly underutilized among Medicare beneficiaries with multiple chronic conditions.
• Barriers to CCM adoption exist, particularly for patients in non-urban areas.
• Strategies to enhance CCM access and earlier chronic condition management may improve adoption and potentially reduce mortality risk.