Exhibit 4:

Potential substitutive versus additive effects on traditional offices visits from adoption of CCM, 2010–2016

Source: Authors’ analysis of data for a 20% random sample of Medicare beneficiaries. Notes: We calculated the number of visits received at each practice per eligible beneficiary (i.e. at least 2 chronic conditions). Baseline office visits included evaluation and management (E&M) visits and other types of office visits i.e. annual wellness visits (AWV) and TCM. High-adopters (n = 577) included those practices (with or without a primary care physician) that were in the top quartile of delivering CCM services to their eligible patients. Non-adopters (n = 31,212) provided CCM to 0% of their eligible patients.

		E&M (and other visits) among High-Adopters	E&M (and other visits) among Non-Adopters	CCM among High-Adopters	CCM among Non-Adopters
2010	High-Adopters	7.52		0
	Non-Adopters		6.56		0
2011	High-Adopters	7.48		0
	Non-Adopters		6.47		0
2012	High-Adopters	7.43		0
	Non-Adopters		6.35		0
2013	High-Adopters	7.31		0
	Non-Adopters		6.25		0
2014	High-Adopters	7.19		0
	Non-Adopters		6.09		0
2015	High-Adopters	7.39		2.03
	Non-Adopters		6.26		0
2016	High-Adopters	6.84		4.26
	Non-Adopters		5.87		0