Table 4.
Characteristics of CPC+ Participants and Nonparticipants Among CPC+ Applicants, Based on Medicare FFS Beneficiary Composition, Before CPC+
| Characteristic | Applicants (n = 4,346)a | Among Applicants
|
P Value | |
|---|---|---|---|---|
| Participants (n = 3,051)b,c | Nonparticipants (n = 1,295) | |||
| Characteristics of Medicare FFS beneficiaries attributed to practice at baseline d | ||||
| Age | ||||
| 0-49 y, % (95% CI) | 6.0 (5.8-6.2) | 5.2 (5.1-5.4) | 7.9 (7.5-8.4) | < .001 |
| 50-64 y, % (95% CI) | 13.1 (12.9-13.4) | 12.0 (11.7-12.2) | 15.9 (15.4-16.4) | < .001 |
| 65-74 y, % (95% CI) | 45.3 (45.0-45.6) | 46.1 (45.8-46.4) | 43.3 (42.7-44.0) | < .001 |
| 75-84 y, % (95% CI) | 24.1 (23.9-24.3) | 24.9 (24.7-25.1) | 22.2 (21.7-22.6) | < .001 |
| ≥ 85 y, % (95% CI) | 11.5 (11.3-11.7) | 11.8 (11.6-12.0) | 10.7 (10.2-11.1) | < .001 |
| Male, % (95% CI) | 41.6 (41.4-41.9) | 41.7 (41.4-41.9) | 41.5 (41.0-42.1) | .664 |
| Race | ||||
| Black, % (95% CI) | 8.5 (8.1-9.0) | 6.9 (6.5-7.4) | 12.3 (11.3-13.4) | < .001 |
| White, % (95% CI) | 84.3 (83.7-84.9) | 85.8 (85.1-86.5) | 80.8 (79.6-82.0) | < .001 |
| Other, % (95% CI) | 7.2 (6.8-7.6) | 7.3 (6.8-7.8) | 6.9 (6.2-7.6) | .383 |
| Dually eligible for Medicare and Medicaid, % (95% CI)e | 17.0 (16.6-17.5) | 14.9 (14.4-15.4) | 22.0 (21.0-23.0) | < .001 |
| HCC score attributed in baseline year, mean (95% CI)f | 1.12 (1.11-1.13) | 1.10 (1.10-1.11) | 1.16 (1.14-1.18) | < .001 |
| Chronic conditions as of baseline yearg | ||||
| Alzheimer disease and related dementia, % (95% CI) | 7.7 (7.5-7.9) | 7.4 (7.2-7.5) | 8.4 (8.0-8.9) | < .001 |
| Cancer, % (95% CI) | 7.6 (7.5-7.7) | 7.9 (7.8-8.0) | 7.0 (6.8-7.1) | < .001 |
| Chronic obstructive pulmonary disease, % (95% CI) | 10.8 (10.7-11.0) | 10.3 (10.2-10.5) | 12.0 (11.6-12.4) | < .001 |
| Chronic kidney disease, % (95% CI) | 16.8 (16.6-17.1) | 16.4 (16.2-16.6) | 17.9 (17.4-18.4) | < .001 |
| Congestive heart failure, % (95% CI) | 11.4 (11.2-11.6) | 11.0 (10.8-11.1) | 12.4 (11.9-12.8) | < .001 |
| Diabetes, % (95% CI) | 26.3 (26.1-26.6) | 25.7 (25.4-26.0) | 27.8 (27.2-28.4) | < .001 |
| Medicare FFS expenditures and service use for Medicare FFS beneficiaries attributed to practice at baseline | ||||
| Medicare expenditures per beneficiary ($/mo), median (IQR)h,i | 858 (744-1,004) | 850 (745-981) | 874 (737-1,090) | < .001 |
| Weighted Medicare expenditures per beneficiary ($/mo), median (IQR)h,i | 855 (761-976) | 849 (757-964) | 869 (768-1,020) | < .001 |
| Acute care stays per 1,000 beneficiaries (annualized), median (IQR) | 282 (233-346) | 276 (231-331) | 302 (239-390) | < .001 |
| ED visits per 1,000 beneficiaries (annualized), median (IQR) | 481 (374-638) | 465 (366-598) | 537 (397-753) | < .001 |
| Primary care (ambulatory) visits per 1,000 beneficiaries (annualized), median (IQR) | 4,471 (3,927-5,161) | 4,443 (3,917-5,087) | 4,565 (3,957-5,503) | < .001 |
| Percentage of discharges for which beneficiary had a 14-day follow-up visit after hospitalization, median (IQR)j | 69.1 (63.0-74.4) | 69.6 (64.0-74.5) | 67.8 (60.4-74.3) | < .001 |
CMS = Centers for Medicare and Medicaid Services; CPC+ = Comprehensive Primary Care Plus; ED = emergency department; FFS = fee for service; HCC = hierarchical condition category; IQR = interquartile range.
Note: Primary care practices include all practices with ≥ 1 practitioner (defined as a physician, nurse practitioner, or physician assistant) with a specialty of primary care (defined as family practice, general practice, geriatrics, or internal medicine). The 2018 starters represent 11% of all practices, 7% of applicants, and 5% of participants.
Sources: Mathematica’s analysis of data on the number, characteristics, and service use and spending of attributed Medicare beneficiaries based on Medicare Enrollment Database and claims data.
A total of 4,599 practices applied for CPC+. The number of applicants in this table (4,346) is fewer because some applicants could not be identified in the SK&A data, and some applicants had no attributed Medicare FFS beneficiaries at baseline.
The 2018 starters comprise approximately 5% of the participating CPC+ practices and 5% of attributed beneficiaries.
As of April 1 of the first intervention year.
The baseline year is 2016 for the 2017 starters and 2017 for the 2018 starters.
Calculated as the percentage of beneficiaries attributed to a practice in the baseline year who were dually eligible for Medicare and Medicaid in the quarter before the start of the baseline year.
The HCC score is based on beneficiaries’ diagnoses in 2015 (for 2017 starters) or 2016 (for 2018 starters).
The lookback periods for the chronic conditions are 3 years before the baseline year for Alzheimer and related dementia, 1 year before the baseline year for cancer and chronic obstructive pulmonary disease, and 2 years before the baseline year for chronic kidney disease, congestive heart failure, and diabetes.
We deflated the 2017 (baseline) mean and median per beneficiary per month expenditures for the practices in the 2018 CPC+ regions by the 0.9% Medicare inflation rate (CMS Office of the Actuary, personal communication, May 6, 2019).
For the calculation of the weighted (mean/median) monthly Medicare expenditures per beneficiary, the practice-level expenditure variable (mean/median) is weighted by the number of beneficiaries attributed to the practice, so that practices with more attributed beneficiaries get a greater weight. The means and medians for all of the other characteristics in the table are unweighted, meaning that each practice is treated equally, regardless of its size.
This measure was calculated for beneficiaries attributed in the first quarter of the baseline year.