Robinson-Ector Kaitlynn S, McCoy Rozalina G, White Whilby Kellee, Yue Dahai, Kleinman Dushanka V, Huang Shuo J, Sehgal Neil Jay
University of Maryland Institute for Health Computing, North Bethesda, MD 20852, United States.
Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
Health Aff Sch. 2025 May 29;3(6):qxaf109. doi: 10.1093/haschl/qxaf109. eCollection 2025 Jun.
Primary care-based care management services are effective ways to care for high-needs and high-risk patients. Despite experiencing higher chronic disease burden, rural Medicare beneficiaries have decreased access to primary care. The Maryland Primary Care Program (MDPCP) is the nation's largest voluntary state-led Medicare demonstration seeking to improve primary care infrastructure and chronic disease prevention and management. With varying access to primary care resources and health care needs among rural and nonrural Medicare beneficiaries, it is important to assess whether there is variation in the implementation of MDPCP care management among rural and nonrural practices. The analyses used Centers for Medicare and Medicaid (CMS) Claims and Claim Line Feed data, MDPCP data, and care transformation requirement reports from 2020-2023 to examine rural and nonrural differences in MDPCP primary care practice-based care management comprehensiveness. MDPCP primary care practice rural status was associated with providing more comprehensive care management services when compared with nonrural primary care practices. Rural MDPCP primary care practices also experienced a greater increase in the comprehensiveness of the care management services provided over time. These results demonstrate how state-led Medicare demonstration programs, such as the MDPCP, can improve rural primary care infrastructure and increase access to care management services.
基于初级保健的护理管理服务是照顾高需求和高风险患者的有效方式。尽管农村医疗保险受益人面临更高的慢性病负担，但他们获得初级保健的机会却减少了。马里兰州初级保健计划（MDPCP）是美国最大的由州主导的自愿性医疗保险示范项目，旨在改善初级保健基础设施以及慢性病的预防和管理。鉴于农村和非农村医疗保险受益人获得初级保健资源和医疗保健需求各不相同，评估农村和非农村医疗机构在实施MDPCP护理管理方面是否存在差异很重要。这些分析使用了医疗保险和医疗补助服务中心（CMS）的理赔和理赔行数据、MDPCP数据以及2020年至2023年的护理转型要求报告，以研究农村和非农村在基于MDPCP初级保健实践的护理管理全面性方面的差异。与非农村初级保健机构相比，MDPCP初级保健机构的农村状况与提供更全面的护理管理服务有关。随着时间的推移，农村MDPCP初级保健机构提供的护理管理服务的全面性也有更大的提升。这些结果表明，像MDPCP这样由州主导的医疗保险示范项目如何能够改善农村初级保健基础设施，并增加获得护理管理服务的机会。
