| Sumario: | Background and Objectives The Centers for Medicare & Medicaid Services launched transitional care management (TCM) and chronic care management (CCM) services to improve care coordination. However, the social determinants of health (SDOH) that affect access to these services remain poorly understood. Research Design and Methods We included Medicare Current Beneficiary Survey participants from 2016 to 2020. 6 SDOH domains: Economic stability; Social support and community; Healthcare access; Transportation; Education; and Neighborhood environment were measured. We performed a conditional logistic regression to model receipt of TCM or CCM as a function of the 6 SDOH domains and covariates. Results 682 TCM cases were matched to 1,364 controls, and 362 CCM cases were matched to 724 controls. Compared to controls, TCM recipients were older (mean [ SD ] age, 76.3 [ SD 10.9] vs 70.9 [13.2] years), as were CCM recipients (74.4 [10.5] vs 73.2 [10.6] years). Greater social disadvantage was associated with lower odds of TCM receipt. Specifically, poorer healthcare access (tertile 2 vs 0: OR 0.61, 95% CI 0.42–0.88) and rural residence (OR 0.48, 95% CI 0.34–0.68) were associated with reduced TCM use. In contrast, greater economic instability (per 1− SD increase: OR 1.16, 95% CI 0.97–1.38) and transportation barriers (OR 1.16, 95% CI 0.99–1.36) were associated with higher odds of CCM use. Discussion and Implications SDOH has divergent associations with TCM and CCM utilization, revealing potential inequities in access to timely post-discharge care, with CCM may be reaching more socially vulnerable individuals.
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