Care Transformation Organization Partnerships Are Associated with Increased Care Management Capabilities Among MDPCP Primary Care Practices

Abstract Background Traditional fee-for-service reimbursement methods limit primary care practices’ ability to invest in the care management services and contribute to limited participation in demonstrations among primary care practicesthat are rural or that disproportionately treat racial and ethnic populations. In response, the Centers for Medicare and Medicaid Services and the Maryland Department of Health designed Care TransformationOrganizations (CTO) to function as care delivery organizations within the Maryland Primary Care Program (MDPCP). The MDPCP is the first primary care demonstration to allow primary care practices to use programmatic funds to facilitate external partnerships with organizations that are equipped to provide services that practices might not maintain inhouse. There are three MDPCP CTO partnership levels where CTOs are responsible for providing 50%, 30%, or 0% of care management services. There is little evidence about whether CTO partnerships improve care management delivery within primary care practices. Objective This analysis seek to examine the associate between CTO partnerships and primary care practice-level care management comprehensiveness. Methods The analyses used CMS Claims and Claim Line Feed data, MDPCP data, and care transformation requirement reports from 2020 to 2023. Linear mixed-effects models and generalized linear mixed-effects models were used to assess the association between MDPCP CTO partnership options and primary care practice-level comprehensive care management composite scores among 486 MDPCP primary care practices. Results Both CTO 30% and CTO 50% partnerships were associated with higher comprehensive care management scores (+0.14–0.15 points) when compared to the CTO 0% partnership option. Conclusion CTO partnerships were associated with increased comprehensiveness of care management services and in the future these partnerships might be leveraged as a resource to encourage smaller practices, rural practices, and practices located in high-needs areas to participate in primary care demonstrations.