Overlap between transitional care management after hospital discharge and alternative payment models.

Abstract

Care coordination is integral during posthospital transitions. The Centers for Medicare & Medicaid Services (CMS) has sought to promote post-hospitalization care coordination through population-based alternative payment models (APMs) and transitional care management (TCM) services. Both can be associated with benefits, but data are lacking about their overlap. Using 2018-2019 100% Medicare claims, we compared characteristics and quantified overlap across APM and TCM groups. Of 7,034,244 beneficiaries and 11,148,266 discharges, 41.6% were APM-aligned and 14.5% involved TCM. TCM services were received in 19.7% of APM-aligned discharges; among discharges involving TCM, 56.7% occurred among APM-aligned beneficiaries. Relative to non-APM beneficiaries, APM-aligned beneficiaries receiving TCM were less likely to be from historically underserved populations, suggesting potential health disparity concerns. This early descriptive analysis offers novel evidence about TCM and APMs as major national policy investments, highlighting the need for future work on overlap and its effects on care coordination and patient outcomes.