Implementing Health Plan-Level Care Management for Solo & Small Practices

摘要 2011年HHS关于多种慢性病的报告强调了患病率、发病率和相关成本 身体和精神上的一系列慢性疾病并存。协作式慢性病护理模式 (CCM)在治疗慢性医疗和精神疾病方面是有效的，只需很少甚至没有净医疗费用。到目前为止 CCMS主要在设施级别实施，并被较大的公共医疗保健采用 组织。然而，绝大多数初级保健和行为健康实践提供 商业保险的医疗保健规模太小，无法实施这种模式。健康计划级别的CCM可以解决 这种未得到满足的需求。基于与Aetna Inc.的开创性合作伙伴关系，本研究的目标是实施 一种旨在改善情绪障碍患者预后的交叉诊断CCM 为单独或小型实践开发可概括的计划级CCM的业务案例。情绪障碍 (抑郁症和双相情感障碍)被安泰确定为优先疾病，因为它们属于慢性疾病 以及高昂的医疗成本。虽然循证护理参数已经建立得很好，但质量 对于有情绪障碍的人来说，医疗和精神护理以及健康结果是次优的。我们会 在安泰中进行交叉诊断CCM与教育对照的随机对照试验 全国各地因单相抑郁或双相情感障碍住院并接受治疗的受益人 在单独或小型初级保健或行为健康实践中。住院时出院时共有172人单独或 总共涉及344名患者的小实践将被随机分配到一年的门诊治疗 通过CCM或教育控制进行增强。CCM组件包括将完全 远离练习场地和患者，由盐湖城的安泰护理管理中心实施 城市、提供商指南支持和基于网络的自我管理支持(人生目标计划)。初级阶段 健康结果是情绪障碍症状、与健康相关的生活质量、住院和指南- 基于情绪障碍和心脏新陈代谢管理。次要结果包括确定 与CCM结果和采用相关的提供者和组织因素，包括卫生信息技术能力、 CCM与教育控制相比的成本效益，以及基于以下内容制定的业务计划 经验数据和利益相关者的意见。拟议的R18解决了AHRQ的研究演示和 传播优先事项，特别是在预防和护理管理方面。除了这一点， 开创性实践-研究伙伴关系侧重于单独或小型实践，以进一步实施CCM 在健康计划层面，这项研究还可能导致交叉诊断CCM业务案例的演变 总体而言，以及计划级小组管理和远程电子健康技术的效用，特别是在 问责性关怀组织和类似倡议的出现。

ABSTRACT The 2011 HHS report on multiple chronic conditions highlighted the prevalence, morbidity, and cost associated with clusters of co-occurring chronic conditions, both physical and mental. Collaborative chronic care models (CCMs) are effective in treating chronic medical and mental illnesses at little to no net healthcare cost. To date CCMs have primarily been implemented at the facility level and adopted by larger, public healthcare organizations. However, the vast majority of primary care and behavioral health practices providing commercially insured care are far too small to implement such models. Health plan-level CCMs can address this unmet need. Based on a groundbreaking partnership with Aetna Inc., the goal of this study is to implement a cross-diagnosis CCM designed to improve outcomes for persons with mood disorders with an eye towards developing a business case for a generalizable plan-level CCM for solo or small practices. Mood disorders (depression and bipolar disorder) were identified by Aetna as priority conditions because of their chronic nature and high healthcare costs. While evidence-based care parameters have been well established, quality of medical and psychiatric care and health outcomes are suboptimal for persons with mood disorders. We will conduct a randomized controlled trial of the cross-diagnosis CCM vs. education control among Aetna beneficiaries across the country who were hospitalized for unipolar depression or bipolar disorder and treated in solo or small primary care or behavioral health practices. At hospitalization discharge a total of 172 solo or small practices involving a total of 344 patients will be randomized to one year of outpatient treatment augmented by the CCM or education control. CCM components include care management that will be fully remote from practice venues and patients, implemented by the Aetna care management center in Salt Lake City, provider guideline support, and web-based self-management support (Life Goals program). The primary health outcomes are mood disorder symptoms, health-related quality of life, hospitalizations, and guideline- based mood disorders and cardiometabolic management. Secondary outcomes include determining the provider and organizational factors associated with CCM outcomes and uptake including health IT capacity, cost effectiveness of the CCM compared to education control, and development of a business plan based on empirical data and stakeholder input. This proposed R18 addresses AHRQ's research demonstration and dissemination priorities, particularly around prevention and care management. In addition to this groundbreaking practice-research partnership focused on solo or small practices to further implement CCMs at the health plan level, this study may also lead to the evolution of the business case for cross-diagnosis CCMs in general, and the utility of plan-level panel management and remote e-health technologies, especially with the advent of accountable care organizations and similar initiatives.