Cost impact of chronic care management services in a large multi-specialty practice: A pragmatic outcomes study

BACKGROUND: Chronic Care Management (CCM) services represent an underutilized Medicare benefit with potential to reduce healthcare costs and improve care coordination for beneficiaries with multiple chronic conditions. OBJECTIVE: To evaluate the real-world impact of CCM services on healthcare expenditures and patient out-of-pocket costs in a large multi-specialty outpatient practice. DESIGN: Pragmatic retrospective cohort study comparing Medicare beneficiaries enrolled in CCM services versus eligible non-enrolled beneficiaries. SETTING: Large multi-specialty outpatient clinic in Alabama with 77 physicians across more than 20 specialties. PARTICIPANTS: Treatment group (n = 6,093) consisted of patients continuously enrolled in CCM services between January 1, 2024 and December 31, 2024. Comparison group (n = 30,432) included eligible patients who were not enrolled in CCM services during the same period. INTERVENTION: Structured CCM program delivered by licensed practical nurses (LPNs) providing monthly telephone or video encounters focused on care plan implementation, medication reconciliation, care coordination, preventive health maintenance, and social determinants of health. MAIN MEASURES: Per-member-per-year (PMPM) paid amounts and patient out-of-pocket expenditures. RESULTS: The CCM treatment group demonstrated 13.6% lower healthcare costs compared to the comparison group ($96 vs. $110 PMPM). Patient out-of-pocket expenses were 16% lower in the treatment group ($29 vs. $34 PMPM). These savings were achieved despite the treatment group being 2% older on average and including 10% more female beneficiaries-both factors typically associated with higher healthcare costs. CONCLUSIONS: Implementation of structured CCM services in a real-world multi-specialty practice setting is associated with reductions in both total healthcare expenditures and patient out-of-pocket costs. These findings support CCM as a practical, cost-effective approach to chronic disease management that benefits patients.