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Association of a Chronic Care Management Model with Health Care Costs and Utilization
Anjali Bhatla1,2, Alexandra K Mueller3, Jason Fu4
1Johns Hopkins Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA. abhatla1@jh.edu.
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.
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