US practice adoption of patient-engagement strategies and spending for adults with diabetes and cardiovascular disease

Abstract

Patient engagement strategies are being encouraged by payers and governments, but with limited evidence about whether practice adoption of these strategies impacts utilization and spending. We examine the association of physician practice adoption of patient engagement strategies (low vs. moderate vs. high) with potentially preventable utilization and total spending for patients with type 2 diabetes and/or cardiovascular disease (CVD) using U.S. physician practice survey (n=2,086) and Medicare fee-for-service (FFS) (n=736,269) data. In adjusted analyses, there were no differences in potentially preventable utilization associated with practice adoption of patient engagement strategies. Compared to patients attributed to practices with moderate adoption, patients attributed to practices with high adoption had higher total spending ($26,364 vs $25,991, p<0.05) driven by spending for long term services and supports (LTSS), including home health agency, long term care, skilled nursing facilities, and hospice payments. In contrast, patients attributed to practices with low adoption had higher total spending ($26,481 vs. $25,991, p<0.01) driven by spending for tests and acute care and clinical access spending. The results highlight that stakeholders that encourage the use of patient engagement strategies should not necessarily expect reduced spending.