Informing Advanced Primary Care Management: Trends From Care Coordination Among Medicare Beneficiaries in 2020-2023.

Abstract

Background: Medicare recently began reimbursing for new advanced primary care management (APCM) services, which builds directly on the design of principal, chronic, and transitional care management. As APCM is anticipated to achieve similar goals and can be used similarly to predecessor services, practice and policy leaders would benefit from insight about collective use of principal, chronic, and transitional care management as APCM adoption begins in the United States.

Methods: Using data encompassing 100% of professional services billed to and reimbursed by Medicare, the authors combined principal, chronic, and transitional care management together as coordination services for evaluation. The authors calculated cumulative sum of service counts and respective reimbursements overall and stratified by clinical specialty and place of service.

Results: A total of 25,269,895 coordination services corresponding to $2,257,471,660 were provided by clinicians to Medicare beneficiaries between 2020 and 2023. Coordination services were most frequently delivered by primary care clinicians, which as a group accounted for 17,210,579 (68%) of services, compared to medical subspecialists, which accounted for 5,718,337 (23%) services, and other specialists, which accounted for 2,340,980 (9%) of services. With respect to place of service, most coordination services occurred in physician offices (21,895,715; 87%) as compared to hospital outpatient departments (757,571; 3%), homes (949,373; 4%), or other care sites (1,667,236; 6%).

Conclusion: This study corroborated the potential benefit of policy decisions to target new coordination services (ie, APCM) toward primary care clinicians, while also highlighting the need to design policies in ways that engage non-primary care clinicians for common chronic conditions.