Differential care demands on Medicare patients by multimorbidity group: care continuity, care coordination, and contact days

Background Patients with multimorbidity face multiple care demands, including the time to access care and the cognitive effort of coordinating care. It is unclear how patients’ experiences with care continuity, coordination, and time burdens (i.e., health care contact days) vary across multimorbidity groups or what role potential protective factors may play. Methods This cross-sectional study used the nationally representative 2022 Medicare Current Beneficiary Survey linked with traditional Medicare claims from the United States. We included continuously enrolled, community-dwelling adults aged ≥ 65 with ≥ 2 chronic conditions. We described self-reported experiences of care continuity and care coordination, health care contact days (receiving ambulatory or institutional care), and telehealth days, home visits, and remote monitoring by multimorbidity group (low: 2–3 chronic conditions, medium: 4–6, high: 7+). Results Among 4424 respondents, care experiences varied by multimorbidity group. Adults in the high multimorbidity group often reported having a usual source of care (96.6%), one provider knowing all of their medical needs (84.4%), and their primary care physician (PCP) being informed about specialist care (81.3%). Fewer patients in the medium and high multimorbidity groups reported satisfaction with co-localized care and ease of managing care, while fewer patients in the low multimorbidity group reported satisfaction with specialist availability. Mean contact days ranged from 12.6 (SD 13.4) per year (low multimorbidity group) to 31.3 (SD 23.9) (high multimorbidity). More patients in the high multimorbidity group used telehealth, home care, and remote monitoring. Conclusions Care experiences vary across multimorbidity groups, with high-multimorbidity patients experiencing greater continuity but also greater difficulty managing care. The findings suggest a potential need to improve specialist access and informational continuity in the low multimorbidity group, support care management and co-localized care in the higher multimorbidity groups and reduce care complexity and potentially avoidable contact days across multimorbidity groups.