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

Principal Investigator: Jodi Summers Holtrop, Ph.D., MCHES
Michigan State University

Purpose

This study investigated the relative effectiveness of provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM) in targeting and engaging at-risk patients and in improving their clinical and utilization outcomes; it also described the implementation of PDCM programs.

Methods

The study used a mixed-method approach, incorporating both quantitative and qualitative methods. Statistical analyses were used to calculate targeting and engagement rates, with data drawn from monthly reports from providers and health plans. Clinical data were drawn from electronic medical records and registries, while utilization data came from claims records. Researchers conducted interviews with and observed practice-based staff to assess implementation and used surveys and interviews to elicit patient perspectives.

Results

PDCM outperformed HPDCM in terms of the percentage of at-risk patients targeted and engaged in the program. While HPDCM patients were higher risk and higher cost at baseline, clinical outcomes did not differ significantly across the two models. PDCM was not statistically significantly better at controlling patients' health care costs than HPDCM during the first year post-care management engagement, but it was directionally promising, particularly for the higher cost group. Qualitatively, practices using well-trained care managers who had been integrated into operations tended to be more satisfied with care management and to use it more routinely.

The Normalization Process Model (theory that explains how new technologies are integrated and implemented in health care settings) helped in identifying factors that facilitated routine use of care management. In summary, while integrated PDCM with well-trained care managers appears to be the more effective model, better targeting of high-risk and high-cost patients is needed to maximize the clinical and cost benefits of PDCM.

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