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A Comparison of Provider Versus Health Plan Delivered Care Management in Michigan

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Over 1 billion dollars is spent annually for contracted companies to deliver disease management programs to adults with chronic conditions, yet evidence of the effectiveness and cost savings of these programs is lacking. Published research suggests that the more disease management is integrated into a patient's primary health care setting, the more effective it is in improving patient outcomes and saving health care dollars. A head-to- head comparison of these approaches - disease management/health insurance company (i.e. vendor) based versus primary care practice (i.e. provider) based disease management - has not been studied. We have a special opportunity to study a demonstration project that seeks to do just that. Blue Cross Blue Shield of Michigan (BCBSM), in partnership with 45 practices from five selected physician organizations (POs), will begin a demonstration project to test provider-delivered chronic disease care management (PDCM). At the same time, BCBSM will continue to deliver their health plan-based (i.e. vendor based) program (HPDCM) for their members in practices not in the demonstration project. We take advantage of this natural experiment in community primary care settings to conduct a comparative effectiveness study of these two care management approaches for adult patients with one and more of five chronic conditions: asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, or diabetes. Using qualitative, quantitative and mixed methods, we will observe, measure and describe the implementation of PDCM in the intervention practices. Using the lens of the Normalization Process Model, we will examine the implementation processes, environments, and the degree of care management integration to identify best practices for PDCM. Finally, we will compare patient outcomes to determine the relative effectiveness of each model of care delivery. The study aims are to: 1) extensively describe the implementation of PDCM in the practices of selected POs (intervention) including the barriers, facilitators, models and features, methods used, and costs to accomplish implementation;2) compare the following patient-specific outcomes between patients offered PDCM versus HPDCM: a) engagement rates in care management, b) relevant clinical indicators, and c) health care utilization;and 3) describe the practice environments and contexts in which BCBSM chronic disease patients receive their care and to identify care management implementation and practice features associated with improved patient engagement and patient-specific outcomes. Research is needed to determine which choice is the best to make with our finite health care dollars: care management delivered by practices and their care teams (PDCM) or care management delivered by health insurers or companies disconnected from practice (vendor based or HPDCM). This study will provide a direct comparison of these two approaches and utilize innovative methods to discover new insights regarding best practices for PDCM within context. Without such studies, comparative effectiveness research will likely have little impact on translating research into practice.

PUBLIC HEALTH RELEVANCE: Nearly one out of every two American adults has at least one chronic illness. Research has shown that care management services can improve chronic disease patient outcomes;however, it is unclear which health care entity is best positioned to provide the most cost-effective patient benefits. This study will compare provider- delivered care management (PDCM) to health plan-delivered care management (HPDCM);seeking to determine the comparative effectiveness of these two approaches on patient participation in care management, clinically relevant health indicators, and healthcare utilization.

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