The Impact of Reimbursement for Non-Face-to-Face Chronic Care Management on Health Utilization Among Patients With Type 2 Diabetes in Louisiana

Published:October 08, 2022DOI:



      We evaluated the impact of reimbursement for non-face-to-face chronic care management (NFFCCM) on healthcare utilization among Medicare beneficiaries with type 2 diabetes in Louisiana.


      We implemented group-based trajectory balancing and propensity score matching to obtain comparable treatment (with NFFCCM) and control (without NFFCCM) groups at baseline. Patients with diabetes with Medicare as their primary payer at baseline were extracted using electronic health records of 3 health systems from Research Action for Health Network, a Clinical Research Network. The study period is from 2013 to early 2020. Our outcomes include general healthcare utilization (outpatient, emergency department, and inpatient encounters) and health utilization related to diabetic complications. We tested each of these outcomes according to multiple treatment definitions and different subgroups.


      Receiving any NFFCCM was associated with an increase in outpatient visits of 657 (95% confidence interval [CI] 626-687; P < .001) per 1000 patients per month, a decrease in inpatient admissions of 5 (95% CI 2-7; P < .001) per 1000 patients per month, and a decrease in emergency department visits of 4 (95% CI 1-7; P = .005) per 1000 patients per month after 24-month follow-up from initial NFFCCM encounter. Both complex and noncomplex NFFCCM significantly increased visits to outpatient services and inpatient admissions per month. Receiving NFFCCM has a dose-response association with increasing outpatient visits per month.


      Patients with diabetes in Louisiana who received NFFCCM had more low-cost primary healthcare and less high-cost healthcare utilization in general. The cost savings of NFFCCM in diabetes management could be further explored in the future.


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        • Forouhi N.G.
        • Wareham N.J.
        Epidemiology of diabetes.
        Medicine (Abingdon). 2014; 42: 698-702
      1. National diabetes statistics report. CDC, 2020
        • American Diabetes Association
        Standards of medical care in diabetes—2014.
        Diabetes Care. 2014; 37: S14-S80
        • Wolff J.L.
        • Starfield B.
        • Anderson G.
        Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.
        Arch Intern Med. 2002; 162: 2269-2276
        • Anderson G.F.
        Medicare and chronic conditions.
        N Engl J Med. 2005; 353: 305
        • Del Valle K.L.
        • McDonnell M.E.
        Chronic care management services for complex diabetes management: a practical overview.
        Curr Diab Rep. 2018; 18: 135
        • Lorig K.R.
        • Sobel D.S.
        • Stewart A.L.
        • et al.
        Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.
        Med Care. 1999; 37: 5-14
        • Peikes D.
        • Chen A.
        • Schore J.
        • Brown R.
        Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials.
        JAMA. 2009; 301: 603-618
        • Strunk B.C.
        • Cunningham P.J.
        Treading water: Americans’ access to needed medical care, 1997-2001.
        Track Rep. 2002; : 1-6
      2. Chronic care management services. CMS.
      3. CY 2015 PFS final rule. Centers for Medicare & Medicaid Services.
        • Schurrer J.
        • O’Malley A.
        • Wilson C.
        • McCall N.
        • Jain N.
        Evaluation of the diffusion and impact of the chronic care management (CCM) services.
        • Basu S.
        • Phillips R.S.
        • Bitton A.
        • Song Z.
        • Landon B.E.
        Medicare chronic care management payments and financial returns to primary care practices: a modeling study.
        Ann Intern Med. 2015; 163: 580-588
        • Bazzano A.N.
        • Wharton M.K.
        • Monnette A.
        • et al.
        Barriers and facilitators in implementing non-face-to-face chronic care management in an elderly population with diabetes: a qualitative study of physician and health system perspectives.
        J Clin Med. 2018; 7: 451
        • Wharton M.K.
        • Shi L.
        • Eragoda S.
        • et al.
        Qualitative analysis of health systems utilizing non-face-to-face chronic care management for Medicare-insured patients with diabetes.
        J Ambul Care Manage. 2020; 43: 326-334
        • Yeager V.A.
        • Wharton M.K.
        • Monnette A.
        • et al.
        Non-face-to-face chronic care management: a qualitative study assessing the implementation of a new CMS reimbursement strategy.
        Popul Health Manag. 2018; 21: 454-461
        • Nichols G.A.
        • Desai J.
        • Elston Lafata J.
        • et al.
        Construction of a multisite DataLink using electronic health records for the identification, surveillance, prevention, and management of diabetes mellitus: the SUPREME-DM project.
        Prev Chronic Dis. 2012; 9: E110
        • Shen Y.
        • Shi L.
        • Nauman E.
        • et al.
        Inverse association between HDL (high-density lipoprotein) cholesterol and stroke risk among patients with type 2 diabetes mellitus.
        Stroke. 2019; 50: 291-297
      4. Chronic conditions data warehouse.
        (Centers for Medicare & Medicaid Services (CMS).)
        Date accessed: February 17, 2021
        • Sweeten G.
        Group-based trajectory models.
        in: Bruinsma G. Weisburd D. Encyclopedia of Criminology and Criminal Justice. Springer, New York, NY2014: 1991-2003
        • Nagin D.S.
        • Jones B.L.
        • Passos V.L.
        • Tremblay R.E.
        Group-based multi-trajectory modeling.
        Stat Methods Med Res. 2018; 27: 2015-2023
        • Haviland A.
        • Nagin D.S.
        • Rosenbaum P.R.
        • Tremblay R.E.
        Combining group-based trajectory modeling and propensity score matching for causal inferences in nonexperimental longitudinal data.
        Dev Psychol. 2008; 44: 422-436
        • Nagin D.S.
        Group-based trajectory modeling: an overview.
        Ann Nutr Metab. 2014; 65: 205-210
        • Shi Q.
        • Mendoza T.R.
        • Gunn G.B.
        • Wang X.S.
        • Rosenthal D.I.
        • Cleeland C.S.
        Using group-based trajectory modeling to examine heterogeneity of symptom burden in patients with head and neck cancer undergoing aggressive non-surgical therapy.
        Qual Life Res. 2013; 22: 2331-2339
        • McDonnell M.E.
        Telemedicine in complex diabetes management.
        Curr Diab Rep. 2018; 18: 42
        • Piette J.D.
        • Weinberger M.
        • McPhee S.J.
        The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial.
        Med Care. 2000; 38: 218-230
        • Hostetter J.
        • Schwarz N.
        • Klug M.
        • Wynne J.
        • Basson M.D.
        Primary care visits increase utilization of evidence-based preventative health measures.
        BMC Fam Pract. 2020; 21: 151
        • Friedberg M.W.
        • Hussey P.S.
        • Schneider E.C.
        Primary care: a critical review of the evidence on quality and costs of health care.
        Health Aff (Millwood). 2010; 29: 766-772
        • Starfield B.
        • Shi L.
        • Macinko J.
        Contribution of primary care to health systems and health.
        Milbank Q. 2005; 83: 457-502
        • Howell E.A.
        • Egorova N.
        • Balbierz A.
        • Zeitlin J.
        • Hebert P.L.
        Black-white differences in severe maternal morbidity and site of care.
        Am J Obstet Gynecol. 2016; 214: 122.e121-122.e127
        • Brown E.J.
        • Polsky D.
        • Barbu C.M.
        • Seymour J.W.
        • Grande D.
        Racial disparities in geographic access to primary care in Philadelphia.
        Health Aff (Millwood). 2016; 35: 1374-1381
        • Gaskin D.J.
        • Dinwiddie G.Y.
        • Chan K.S.
        • McCleary R.R.
        Residential segregation and the availability of primary care physicians.
        Health Serv Res. 2012; 47: 2353-2376