Comprehensive care management variation between rural and nonrural Maryland Primary Care Program (MDPCP) practices.

Primary care-based care management services are effective ways to care for high-needs and high-risk patients. Despite experiencing higher chronic disease burden, rural Medicare beneficiaries have decreased access to primary care. The Maryland Primary Care Program (MDPCP) is the nation's largest voluntary state-led Medicare demonstration seeking to improve primary care infrastructure and chronic disease prevention and management. With varying access to primary care resources and health care needs among rural and nonrural Medicare beneficiaries, it is important to assess whether there is variation in the implementation of MDPCP care management among rural and nonrural practices. The analyses used Centers for Medicare and Medicaid (CMS) Claims and Claim Line Feed data, MDPCP data, and care transformation requirement reports from 2020-2023 to examine rural and nonrural differences in MDPCP primary care practice-based care management comprehensiveness. MDPCP primary care practice rural status was associated with providing more comprehensive care management services when compared with nonrural primary care practices. Rural MDPCP primary care practices also experienced a greater increase in the comprehensiveness of the care management services provided over time. These results demonstrate how state-led Medicare demonstration programs, such as the MDPCP, can improve rural primary care infrastructure and increase access to care management services.