CCM) Services: Final Report

FINAL REPORT Evaluation of the Diffusion and Impact of the Chronic Care Management (CCM) Services: Final Report November 2, 2017 John Schurrer Ann O’Malley Claire Wilson (Insight Policy Research) Nancy McCall Neetu Jain Submitted to: Sai Ma, Contracting Officer Representative Center for Medicare & Medicaid Innovation Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Contract Number: HHSM-500-2014-00034I Submitted by: Mathematica Policy Research 1100 1st Street, NE, 12th Floor Washington, DC 20002-4221 Telephone: (202) 484-9220 Facsimile: (202) 863-1763 Project Director: Nancy McCall Reference Number: 50131 This page has been left blank for double-sided copying. MATHEMATICA POLICY RESEARCH ACKNOWLEDGMENTS We would like to thank Sai Ma at the Center for Medicare & Medicaid Innovation and the other members of our project team, including Eugene Rich, for their guidance and feedback on the content of this report. We would also like to especially thank Kevin Bradway, Alex Prociuk, Matt Mleczko, and Tessa Huffman for their programming and logistical support. iii This page has been left blank for double-sided copying. MATHEMATICA POLICY RESEARCH CONTENTS EXECUTIVE SUMMARY .............................................................................................................................. xi I. BACKGROUND AND OVERVIEW OF REPORT ............................................................................ 1 II. MEDICARE BENEFICIARY AND PROVIDER EXPERIENCE ........................................................ 3 A. Beneficiary experience .............................................................................................................. 3 1. Methods .............................................................................................................................. 3 2. Results ................................................................................................................................ 6 3. Discussion ......................................................................................................................... 11 B. Provider experience ................................................................................................................. 11 1. Methods ............................................................................................................................ 12 2. Results .............................................................................................................................. 14 3. Discussion ......................................................................................................................... 26 III. UPTAKE, DIFFUSION, AND IMPACT OF THE CHRONIC CARE MANAGEMENT SERVICE ....................................................................................................................................... 29 A. Descriptive statistics on uptake and diffusion of CCM services, characteristics of CCM beneficiaries and providers, and overlap CCM services with other care management services ............................................................................................................. 29 1. Beneficiary uptake and characteristics ............................................................................. 29 2. Provider uptake and characteristics .................................................................................. 35 3. Impact of the CCM payment policy on the CPC and MAPCP models and other care management service provision ................................................................................. 37 B. Data and methods for impact estimation ................................................................................. 40 1. Data ................................................................................................................................... 40 2. Identification of a matched comparison group .................................................................. 40 3. Impact methodology .......................................................................................................... 44 C. Impact of CCM services on beneficiary expenditures, utilization, and quality of care ............ 48 1. Expenditures ..................................................................................................................... 50 2. Service utilization .............................................................................................................. 54 3. Quality of care ................................................................................................................... 55 4. Sensitivity tests ................................................................................................................. 57 D. CCM and Medicare long-term program savings ...................................................................... 58 IV. DISCUSSION ................................................................................................................................. 59 REFERENCES ............................................................................................................................................ 63 APPENDIX A: SEMISTRUCTURED INTERVIEW PROTOCOLS FOR BENEFICIARIES .......................A-1 v CONTENTS MATHEMATICA POLICY RESEARCH APPENDIX B: SEMI-STRUCTURED INTERVIEW PROTOCOL FOR THE ELIGIBLE PROFESSIONALS (EP) ..................................................................................................B-1 APPENDIX C: SEMISTRUCTURED INTERVIEW PROTOCOL FOR PROFESSIONAL SOCIETY REPRESENTATIVES ..................................................................................................... C-1 APPENDIX D: PROPENSITY SCORE MATCHING DIAGNOSTICS ...................................................... D-1 APPENDIX E: DESCRIPTION OF OUTCOME MEASURES ...................................................................E-1 APPENDIX F: 6- AND 12-MONTH MEDICARE EXPENDITURE, UTILIZATION, AND QUALITY OF CARE IMPACT ESTIMATES ..................................................................................... F-1 APPENDIX G: SENSITIVITY TESTS FOR 6- AND 18-MONTH PBPM TOTAL MEDICARE EXPENDITURE IMPACT ESTIMATES .......................................................................... G-1 vi MATHEMATICA POLICY RESEARCH TABLES II.1 Characteristics of beneficiary respondents ...................................................................................... 5 II.2 Characteristics of respondents and their practices ........................................................................ 15 III.1 Months of CCM services received, January 2015–December 2016 ............................................. 31 III.2 Demographics and health status of Medicare FFS CCM recipients and the general Medicare FFS population, January 2015–December 2016 ........................................................... 33 III.3 Top 10 HCCs and claims-based frailty indicators among CCM beneficiaries ............................... 34 III.4 CCM claims submitted by specialty, January 2015–December 2016 ........................................... 37 III.5 Overlap in payment for care management services provided by CPC practices and other providers to beneficiaries attributed to CPC and MAPCP practices: January 1, 2015, through December 31, 2016 .......................................................................................................... 39 III.6 Baseline variables used in the propensity score models ............................................................... 42 III.7 Sample sizes before and after matching........................................................................................ 44 III.8 Outcome measures and corresponding regression models .......................................................... 46 III.9 Outcomes by domain ..................................................................................................................... 49 III.10 Estimated PBPM differences between CCM and comparison beneficiaries by cohort and follow-up period .............................................................................................................................. 52 III.11 Estimated PBPM differences between CCM and comparison beneficiaries: 12-month expenditure outcomes (without CCM fee)...................................................................................... 53 III.12 Estimated differences between CCM and comparison beneficiaries: 12-month follow-up utilization outcomes ........................................................................................................................ 55 III.13 Estimated differences between CCM and comparison beneficiaries: 12-month quality of care outcomes ................................................................................................................................ 56 III.14 Sensitivity tests for 12-month PBPM total Medicare expenditure outcomes (without CCM fee) ................................................................................................................................................. 57 D.1 Matching model diagnostics: January–March 2015 ..................................................................... D-5 D.2 Matching model diagnostics: April–June 2015 ............................................................................ D-7 D.3 Matching model diagnostics: July–September 2015 ................................................................... D-9 D.4 Matching model diagnostics:

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