The American Journal of Managed Care May 2015
Results From a National Survey on Chronic Care Management by Health Plans
Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their populations, regardless of plan size, location, or ownership status. Also, health plan approaches to chronic care management are evolving. On the member-facing side, health plans are matching resources more closely to member needs through risk stratification and predictive modeling, which allows targeting of high-risk patients with resource-intense services. On the provider-facing side, plans are redesigning care delivery and payment models that include integration of health plan chronic care management services with provider office work flow. Internally, plans are bringing more components of their program inhouse to facilitate coordination and integration.
This evolution toward increased collaboration with providers in delivering chronic care services more closely mirrors elements of the Chronic Care Model.6 This shift is important because evidence suggests that “light-touch” models of chronic care management are not effective. The Medicare Health Support Demonstration,7 a trial of remote disease management, achieved only modest improvements in quality-of-care measures, with no significant reduction in the utilization and cost. In contrast, evidence appears to suggest that a combination of interventions that include patient education, clinical decision support, and reminders can lead to improved outcomes.8-10
First, with a response rate of 36%, we cannot rule out the possibility that the findings are not fully generalizable to all health plans. While participating and nonparticipating plans were statistically similar with respect to overall enrollment, region of operation, and ownership status, plans may have differed in non-observable characteristics. To mitigate this concern, the health plans respond-ing to the survey accounted for 51% of the commercial enrollees in our sample and 22% of the overall sampling frame of health plans with more than 50,000 commercial enrollees. The findings from our study therefore apply to a majority of the sample health plan enrollees and to almost a quarter of organizations. Additionally, since our sample was randomly drawn, we believe that these results can be reasonably extrapolated to a national population. Finally, this study was focused on health plans and does not reflect the experience of patients and providers who participate in these programs. Despite these limitations, our findings provide new insights into the practices of health plans in chronic care management.
We find that chronic care management programs have become a standard offering of health plans. To date, there is a lack of clear scientific evidence on the combinations of interventions and their relative intensity that can help to ensure improved outcomes for patients with chronic disease. Therefore, there is a need for well-designed studies in this area, including evidence on methods that are most effective for increasing patient participation and retention, and for achieving long-term behavioral change. The current unsatisfactory nature of the status quo presents an enormous opportunity to improve care and health for chronically ill patients.
The authors would like to thank the health plan staff that generously contributed their time and insights to the survey and the case studies. They also thank Liz Sloss, Lisa Klautzer and Todi Mengistu for their work on data acquisition and preparation, and Patrick Orr for his help in preparing this manuscript.
Author Affiliations: RAND Corporation, Boston, MA (SM), and Santa Monica, CA (RB); America’s Health Insurance Plans (AH), Washington, DC.
Source of Funding: America’s Health Insurance Plans Foundation.
Author Disclosures: Dr Mattke was a webinar speaker for Shape-Up, Inc. Dr Brook owns stock in Steris, United Health Group, and Complex Care Solutions. Dr Higgins reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (RB, AH, SM); acquisition of data (SM); analysis and interpretation of data (SM, AH); drafting of the manuscript (AH, SM); critical revision of the manuscript for important intellectual content (RB, SM); statistical analysis (SM); provision of patients or study materials (AH); obtaining funding (RB, SM); administrative, technical, or logistic support (RB); and supervision (RB, AH, SM).
Address correspondence to: Soeren Mattke, MD, DSc, RAND Health Advisory Services, 20 Park Plaza #920, Boston, MA 02116. E-mail: firstname.lastname@example.org.
3. DeVol R, Bedroussian A, Charuworn A, et al. An unhealthy America: the economic burden of chronic disease [report]. Santa Monica, CA: Milken Institute; 2007.
5. America’s Health Insurance Plans. Health Insurance Plans’ Innovative Initiatives to Combat Cardiovascular Disease. Washington, DC: America’s Health Insurance Plans; 2012. http://www.ahip.org/Innovations_Series/. Accessed April 2015.
6. Wagner EH, Austin BT, Michael VK. Organizing care for patients with chronic illness. Milbank Q. 1996:74(4): 511-544.