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

Luo, Zhehui; Chen, Qiaoling; Annis, Ann; Piatt, Gretchen; Green, Lee A.; Tao, Min; Holtrop, Jodi Summers

doi:10.1007/s11606-016-3617-2

Cited by 12 publications

(9 citation statements)

References 28 publications

(33 reference statements)

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“…Because the study from which these data were gathered was a natural experiment conducted by health insurers, the practices were not randomized to intervention. Quantitative results comparing care management outcome to controls have been published as separate manuscripts [ 26 , 27 ]. This paper reports on the qualitative analysis of the overall study on implementation process within practices and compares those findings across practices.…”

Section: Methodsmentioning

confidence: 99%

Effect of care management program structure on implementation: a normalization process theory analysis

Holtrop

Potworowski

Fitzpatrick

et al. 2016

BMC Health Serv Res

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BackgroundCare management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice.MethodsData collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework.ResultsSeventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship (relational integration) developed between practice providers and staff and the care manager. When any of these elements were missing, care management implementation appeared to be affected negatively.ConclusionsAlthough care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program with a view to addressing them during implementation planning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1613-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Effect of care management program structure on implementation: a normalization process theory analysis

Holtrop

Potworowski

Fitzpatrick

et al. 2016

BMC Health Serv Res

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“…Smaller studies of care manager implementation have found that clinical staff within primary care practices support having onsite or embedded care managers, as opposed to case management by off-site health plan or disease management companies, as the most effective form of patient engagement in disease management. 11,12 However, studies of the early implementation of embedded care managers have identified physician and staff concerns that the care managers interfere with their work. 13 Others have found that while many physicians and staff members appreciate the relationship between the care manager and patients, some felt threatened by a perceived weakening of their own relationship with patients.…”

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confidence: 99%

“…8 Many of these studies followed physicians and staff for only a short period of time and included only a small number of practices within the sample. 8,[11][12][13] The objectives of the current study were twofold: (1) to assess the acceptability of care managers among staff and physicians within primary care practices across a large, state-wide demonstration program, and (2) to evaluate whether the amount of time a care manager spends physically located within a practice (level of care manager embedment) is predictive of staff and physician acceptability after adjusting for a variety of survey respondent and practice characteristics.…”

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Physician and Staff Acceptance of Care Managers in Primary Care Offices

Malouin

Sarinopoulos

et al. 2017

J Am Board Fam Med

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Introduction: Embedded care managers are increasingly implemented as part of the care team within primary care practices, yet previous studies have indicated variability in acceptance by physicians and staff. This study assesses the acceptability of care managers among staff and physicians within the Michigan Primary Care Transformation (MiPCT) demonstration.Methods: Care manager acceptance was measured using a web-based survey distributed to practices participating in the MiPCT demonstration. Results: Both physicians and staff reported high levels of care manager acceptance. Longer length of care manager employment at the practice, higher care manager FTE dedicated to care management, and care manager employed by practice were all significantly associated with care manager acceptance.

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“…These programs attempt to improve chronic disease management through frequent telephone contact, usually by nurses, with patients at high risk for adverse outcomes or extreme costs. In contrast, many primary care practices have incorporated chronic care management as they work towards establishing themselves as Bmedical homes.^In a quasi-experimental study directly comparing these two types of programs for patients with one or more chronic illnesses, Luo et al 4 basically called it a wash. However, there was substantial heterogeneity in primary care management plan implementation.…”

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confidence: 99%

Getting from Intention to Action

Kravitz

Reisman

2016

J GEN INTERN MED

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M any of the most pressing problems in human health are not a direct result of genetic error or environmental insult, but rather human behavior. We know quite a bit about how to be healthy: eat less, exercise more, don't smoke, and seek high-quality medical care when you need it. Judging by the prevalence of obesity, sedentary lifestyle, smoking, and inappropriate and/or poorly delivered care, this is apparently easier said than done. The problem of health-related behavior (which includes the behavior of health professionals as well as patients) is, in large measure, a matter of motivation. We have good intentions aplenty. What we need is action.So how do we motivate patients and the health professionals who care for them? Several articles in this issue of JGIM address this perpetually challenging question. Two papers focus on clinician education and skill building. As demonstrated in the observational study by Boissy et al., 1 it's hard for burned-out physicians to motivate patients. A relationshipcentered communication skills course not only increased empathy and decreased burnout in physicians, but the patients of these physicians reported improved satisfaction with care.

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

Cited by 12 publications

References 28 publications

Effect of care management program structure on implementation: a normalization process theory analysis

Effect of care management program structure on implementation: a normalization process theory analysis

Physician and Staff Acceptance of Care Managers in Primary Care Offices

Getting from Intention to Action

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