Observational Maryland study links chronic care management to lower acute care use

A comprehensive chronic care management program was associated with fewer hospital admissions and emergency department visits among high-risk patients attributed to Maryland primary care practices, according to an observational pre-post study with a concurrent comparison group and propensity-score matching. The analysis included 3,657 patients, of whom 1,219 engaged with chronic care management and 2,438 non-engaged patients were randomly sampled as controls. In the matched cohort of 2,370 patients, participation was associated with 0.22 fewer hospitalizations and 0.20 fewer emergency department visits per person during the six months after the index date. Acute care expenditures were $3,008 lower among chronic care management participants. There was no significant between-group difference in 30-day readmissions in either the unmatched or matched analyses.

The study examined high-risk patients attributed to primary care practices supported by the Johns Hopkins Care Transformation Organization and participating in the Maryland Primary Care Program between December 2021 and January 2024. Investigators measured acute hospitalizations, emergency department visits, 30-day readmissions and associated acute care expenditures during the six months before and after each patient’s index date. The design allowed the researchers to compare changes among patients who engaged with chronic care management with concurrent changes among randomly sampled non-engaged patients. Because the study was observational, however, its estimates demonstrate an association between program engagement and subsequent outcomes rather than establishing that the program caused the differences.

The intervention was delivered through a multidisciplinary team that included registered nurse care managers, supported by pharmacy, behavioral health and community health worker services as clinically indicated. Chronic care management programs aim to reduce avoidable acute care utilization through improved care coordination, but the supplied study notes that evidence about their effectiveness among high-risk patients has remained mixed. An important feature of this cohort was that participants had substantially higher baseline acute care utilization than the non-engaged comparison group. Propensity-score matching was used to improve comparability when estimating the association between engagement and outcomes during the follow-up period.

In the unmatched analysis, chronic care management engagement was associated with a 54% relative reduction in hospitalizations, with an incidence rate ratio of 0.46 and a 95% confidence interval of 0.35 to 0.62. Emergency department visits were 33% lower, with an incidence rate ratio of 0.67 and a 95% confidence interval of 0.52 to 0.85. The propensity-score–matched analysis yielded an average treatment effect on the treated of −0.22 for hospitalizations, with a 95% confidence interval of −0.29 to −0.16, and −0.20 for emergency department visits, with a 95% confidence interval of −0.28 to −0.13. For 30-day readmissions, the matched estimated effect was 0.00, with a 95% confidence interval of −0.03 to 0.03; the study therefore found no significant between-group difference in readmissions.

The results connect engagement with a comprehensive care model to reduced hospitalizations, fewer emergency department visits and lower associated acute care spending in a high-risk primary care population. The clearest signals involved hospital and emergency department use rather than readmissions, for which no significant between-group difference was detected. Interpretation is limited by the observational design, the focus on one Maryland program and the marked imbalance in baseline utilization between participants and controls. Although the concurrent comparison group and propensity-score matching improved comparability, they could not eliminate all potential differences between patients or prove causation. The evidence therefore supports an association between chronic care management engagement and lower acute care utilization and expenditures, not a definitive conclusion that the program alone produced those outcomes.

Subject of Research: Chronic care management and acute care utilization among high-risk Maryland primary care patients

Article Title: Association of a Chronic Care Management Model with Health Care Costs and Utilization

Article References: Bhatla, A., Mueller, A. K., Fu, J., Norman, T., Eldridge, J., Tschudy, M. M., & Berkowitz, S. A. (2026). Association of a Chronic Care Management Model with Health Care Costs and Utilization. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10948-9

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10948-9

Keywords: chronic care management, health care utilization, hospital admissions, emergency department visits, 30-day readmissions, acute care expenditures, care coordination, propensity-score matching, high-risk patients, primary care, Association, Chronic