A team of Korean-American researchers affiliated with multiple Boston and Korea-based institutions including the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston and Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and colleagues sought to better understand actual utilization of Chronic Care Management (CCM) services, the program launched by the Centers for Medicare and Medicaid Services (CMS) in 2015 for patients with multiple chronic diseases. As we have reported previously, not that many studies have formally investigated the utilization of CCM services by geographic region, sociodemographic, and clinical characteristics. In this latest study, represented by corresponding author Dae Hyun Kim MD, MPH, ScD at Harvard University and colleagues tapped into and analyzed Medicaid claims data from 2014 to 2019 based on a 5% random sampling of fee-for-service beneficiaries aged 65 years and up. Including only those beneficiaries eligible for CCM services (e.g., 2+ chronic conditions) ( 1,073,729 in 2015 and 1,130,523 in 2019) the calculation included the proportion of potentially eligible beneficiaries receiving CCM service each year for the total population and by geographic region, sociodemographic, and clinical characteristics. The findings evidence a substantial lack of utilization of the CCM program in the first handful of years. We suspect this less than adequate utilization of CCM services continues.

The recent findings were reported in the Journal of the American Geriatrics Society just in July 2024.

Findings

Jieun Jang PhD and Dr. Hyun Kim and colleagues found a three-fold growth in service. “The proportion of beneficiaries with two or more chronic conditions receiving CCM services increased from 1.1% in 2015 to 3.4% in 2019.”

Interestingly CCM services were utilized more based on this scientific random sampling in the southern region, among dually eligible beneficiaries and beneficiaries with a greater burden of chronic conditions (2–5 conditions vs ≥10 conditions: 0.7% vs 2.0% in 2015; 2.1% vs 7.0% in 2019) and frailty (robust vs severely frail: 0.6% vs 3.3% in 2015; 1.9% vs 9.4% in 2019).

Nearly one out of five recipients did not continue CCM service after the initial service, meaning 20% dropped out of the program during the 2015 to 2019 time frame.

Summary and CrossTx Vantage

Not surprisingly as this mirrors our experience especially in the first five years of the program. Note CrossTx launched CCM software and supportive services with HealthTech in 2015, making the partners some of the first, if not the first group to develop CCM solutions. According to the study’s authors “CCM service is being used by a very small fraction of eligible patients.”

What kinds of challenges and opportunities are associated with this situation. According to Dr. Hyun Kim and colleagues “Barriers and facilitators to more effective CCM adoption should be identified and incorporated into strategies that encourage more widespread use of this Medicare benefit.”

CrossTx has learned substantially about barriers to adoption, including a talent shortage, the phenomenon of nurses leaving the clinic, conflicting pressure on clinic staff, a lack of sufficient training, questionable outsourcing models including call centers and more.

Funding

• National Institute on Aging of the National Institutes of Health
• Korea Health Technology R&D
• Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea

Lead Research/Investigator

• Jieun Jang PhD, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA; Department of Hospital Administration, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
• Dae Hyun Kim MD, MPH, ScD; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Source: the Journal of the American Geriatrics Society