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Erschienen in:

07.03.2016 | Original Research

A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes

verfasst von: Zhehui Luo, MS, PhD, Qiaoling Chen, MS, Ann M. Annis, PhD, RN, Gretchen Piatt, MPH, PhD, Lee A. Green, MD, MPH, Min Tao, PhD, Jodi Summers Holtrop, PhD, MCHES

Erschienen in: Journal of General Internal Medicine | Ausgabe 7/2016

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ABSTRACT

BACKGROUND

The real world implementation of chronic care management model varies greatly. One aspect of this variation is the delivery mode. Two contrasting strategies include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM).

OBJECTIVE

We aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases.

DESIGN

We used a quasi-experimental two-group pre-post design using the difference-in-differences method.

PATIENTS

Commercially insured patients, with any of the five chronic diseases—congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes, or asthma, who were outreached to and engaged in either PDCM or HPDCM were included in the study.

MAIN MEASURES

Outreached patients were those who received an attempted or actual contact for enrollment in care management; and engaged patients were those who had one or more care management sessions/encounters with a care manager. Effectiveness measures included blood pressure, low density lipoprotein (LDL), weight loss, and hemoglobin A1c (for diabetic patients only). Primary endpoints were evaluated in the first year of follow-up.

KEY RESULTS

A total of 4,000 patients were clustered in 165 practices (31 in PDCM and 134 in HPDCM). The PDCM approach demonstrated a statistically significant improvement in the proportion of outreached patients whose LDL was under control: the proportion of patients with LDL < 100 mg/dL increased by 3 % for the PDCM group (95 % CI: 1 % to 6 %) and 1 % for the HPDCM group (95 % CI: −2 % to 5 %). However, the 2 % difference in these improvements was not statistically significant (95 % CI: −2 % to 6 %). The HPDCM approach showed 3 % [95 % CI: 2 % to 6 %] improvement in overall diabetes care among outreached patients and significant reduction in obesity rates compared to PDCM (4 %, 95 % CI: 0.3 % to 8 %).

CONCLUSIONS

Both care management delivery modes may be viable options for improving care for patients with chronic diseases. In this commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients’ clinical indicators in the first year. Different care management strategies within the provider-delivered programs need further investigation.

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Titel: A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes
verfasst von: Zhehui Luo, MS, PhD
Qiaoling Chen, MS
Ann M. Annis, PhD, RN
Gretchen Piatt, MPH, PhD
Lee A. Green, MD, MPH
Min Tao, PhD
Jodi Summers Holtrop, PhD, MCHES
Publikationsdatum: 07.03.2016
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 7/2016
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-016-3617-2

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A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes