OBJECTIVES

: To improve chronic care management, the Centers for Medicare and Medicaid Services (CMS) implemented new reimbursement codes for non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions on January 1, 2015. This study aimed to evaluate the impact of this reimbursement policy on healthcare utilization among Medicare beneficiaries with type 2 diabetes in Louisiana.

METHODS

: This study was a retrospective observational cohort study of 118,576 patients with type 2 diabetes using statewide Medicare claims data in Louisiana from 2014 to 2018. Baseline data on demographics and chronic conditions were collected before the first NFFCCM encounter. Group-based trajectory balancing and propensity score weighting methods were used to obtain comparable treatment with the NFFCCM reimbursement (n=8,047) and control (n=110,528) groups. Healthcare utilization outcomes included monthly inpatient, outpatient, and emergency department (ED) encounters. Multiple linear regression models were developed to assess the impact of NFFCCM on each outcome, controlling for demographics, chronic conditions, baseline monthly inpatient, outpatient, and ED encounters, months in sample before first receiving NFFCCM, and outpatient trajectories at baseline.

RESULTS

: After propensity score weighting, the characteristics of treatment and control groups were well-balanced at baseline: The baseline monthly hospital admissions were 0.04, the monthly ER visits were 0.08, and the monthly outpatient visits were 2.55 for both groups. Receiving any NFFCCM was associated with a significant decrease in monthly hospital admissions (0.013, p<0.001), decrease in monthly ED utilization per month (0.018, p<0.001), and increase in monthly outpatient utilization per month (0.018, p<0.001).

CONCLUSIONS

: This study found that NFFCCM reduced hospital admissions and ED utilization and increased outpatient utilization. The policy is associated with shifting of patient care from the ED and inpatient settings to outpatient visits, which is a major goal when attempting to provide chronic disease care in lower cost settings.