RE4 The IMPACT of Reimbursement for NON-Face-to-Face Chronic Care Management on Health Outcomes and Health Care Utilization Among Patients with Type 2 Diabetes in Louisiana

Abstract

This study aimed to evaluate the impact of non-face-to-face chronic care management (NFFCCM) services on multiple health outcomes and utilizations among Medicare beneficiaries with diabetes in Louisiana Type 2 diabetes patients with Medicare as their primary payer at baseline were extracted using 2013 to early 2020 electronic health records from the Research Action for Health Network (REACHnet) database. The treatment cohort was defined by the index NFFCCM codes: 99490 or complex NFFCCM codes: 99487, and 99489. Group-based trajectory balancing and propensity score matching was used to obtain comparable treatment (with NFFCCM) and control (without NFFCCM) groups at baseline. The primary outcome is glycemic control measured by hemoglobin A1c (HbA1c). Secondary outcomes include health utilization (outpatient visits, emergency department visits, and inpatient admissions) and diabetic complication rates (coronary heart disease, stroke, and major adverse cardiovascular events). We tested each of these outcomes across various frequencies of NFFCCM receipt over 6 and 12 months. We found a positive impact of NFFCCM on diabetes management in a well-balanced sample. Receiving any NFFCCM was associated with a reduction in HbA1c of 0.058% (P<0.001), an increase in outpatient visits of 0.723 (p<0.001) per month, a decrease in inpatient admissions of 0.006 (p<0.001) per month, and a decrease in ED visits of 0.003 (p<0.001) per month during a 24-month follow-up period after the first NFFCCM encounter. After receiving NFFCCM, treated individuals were 2.1% (p<0.001) more likely to have an HbA1c less than 7% during a 24-month follow-up period after the first NFFCCM encounter. Both complex and non-complex NFFCCM significantly increased visits to outpatient services and decreased inpatient admissions. We did not find significant improvements in diabetic complication outcomes. Our analysis found NFFCCM was associated with better glycemic control, more outpatient visits, fewer inpatient admissions, and fewer ED visits among patients with type 2 diabetes