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

描述（由申请人提供）：签约公司每年花费超过10亿美元为患有慢性疾病的成年人提供疾病管理项目，但缺乏这些项目的有效性和成本节约的证据。已发表的研究表明，疾病管理越融入患者的初级卫生保健环境，就越能有效地改善患者的治疗结果，并节省卫生保健费用。这些方法——基于疾病管理/健康保险公司（即供应商）与基于初级保健实践（即提供者）的疾病管理——的正面比较尚未进行研究。我们有一个特殊的机会来研究一个示范项目，试图做到这一点。密歇根州蓝十字蓝盾公司（BCBSM）将与5家选定的医生组织（POs）的45家诊所合作，开始一个示范项目，测试由提供者提供的慢性病护理管理（PDCM）。同时，BCBSM将继续在示范项目之外的实践中为其成员提供基于健康计划（即基于供应商）的方案（HPDCM）。我们利用社区初级保健机构的自然实验，对患有哮喘、慢性阻塞性肺病、充血性心力衰竭、冠状动脉疾病或糖尿病等五种慢性疾病中的一种或多种的成年患者进行两种护理管理方法的比较有效性研究。我们将采用定性、定量和混合方法，观察、测量和描述PDCM在干预实践中的实施情况。使用规范化流程模型的视角，我们将检查实现流程、环境和护理管理集成程度，以确定PDCM的最佳实践。最后，我们将比较患者的结果，以确定每种护理模式的相对有效性。本研究的目的是：1)广泛描述PDCM在选定的POs（干预）实践中的实施，包括实现实施的障碍、促进因素、模型和特征、使用的方法和成本；2)比较PDCM与HPDCM患者的以下患者特异性结局：a)护理管理参与度，b)相关临床指标，c)医疗保健利用；3)描述BCBSM慢性疾病患者接受护理的实践环境和背景，并确定与改善患者参与和患者特异性结果相关的护理管理实施和实践特征。需要进行研究，以确定在我们有限的医疗保健资金中，哪种选择是最好的：由实践及其护理团队提供的护理管理（PDCM），还是由与实践脱节的健康保险公司或公司提供的护理管理（基于供应商或HPDCM）。本研究将提供这两种方法的直接比较，并利用创新的方法来发现关于PDCM最佳实践的新见解。如果没有这样的研究，比较有效性研究可能对将研究转化为实践几乎没有影响。

DESCRIPTION (provided by applicant): 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.