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

描述(申请人提供)：合同公司每年花费超过10亿美元为患有慢性病的成年人提供疾病管理计划，但缺乏这些计划的有效性和成本节约的证据。已发表的研究表明，疾病管理越多地融入患者的初级保健环境，在改善患者结局和节省医疗保健资金方面就越有效。这些方法--基于疾病管理/健康保险公司(即供应商)的方法与基于初级保健实践(即提供者)的疾病管理方法--之间的正面比较尚未得到研究。我们有一个特殊的机会来研究一个旨在做到这一点的示范项目。密歇根州蓝十字蓝盾(BCBSM)将与来自五个选定医生组织(POS)的45家诊所合作，开始一个示范项目，以测试提供者提供的慢性病护理管理(PDCM)。与此同时，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)的计划(HPDCM)。我们利用社区初级保健环境中的这一自然实验，对患有五种或五种以上慢性疾病的成人患者进行了这两种护理管理方法的比较有效性研究：哮喘、慢性阻塞性肺疾病、充血性心力衰竭、冠状动脉疾病或糖尿病。采用定性、定量和混合的方法，对PDCM在干预实践中的实施情况进行观察、测量和描述。使用标准化流程模型的镜头，我们将检查实施流程、环境和护理管理集成的程度，以确定PDCM的最佳实践。最后，我们将比较患者的结果，以确定每种护理提供模式的相对有效性。这项研究的目的是：1)广泛描述PDCM在选定的POS(干预)实践中的实施情况，包括障碍、促进者、模型和特点、使用的方法以及完成实施的成本；2)比较提供PDCM和HPDCM的患者的以下特定患者的结果：a)护理管理参与率，b)相关临床指标，c)医疗保健利用；3)描述BCBSM慢性病患者接受护理的实践环境和背景，并确定与患者参与度和患者特定结果相关的护理管理实施和实践特征。需要进行研究，以确定利用我们有限的医疗保健资金做出哪种选择是最佳选择：由实践及其护理团队(PDCM)提供的护理管理，还是由健康保险公司或与实践脱节的公司提供的护理管理(基于供应商或HPDCM)。这项研究将对这两种方法进行直接比较，并利用创新方法在背景下发现关于PDCM最佳做法的新见解。如果没有这样的研究，比较有效性研究很可能对将研究转化为实践几乎没有影响。 与公共健康相关：几乎每两个美国成年人中就有一个至少患有一种慢性病。研究表明，护理管理服务可以改善慢性病患者的预后；然而，目前尚不清楚哪个卫生保健实体最适合提供最具成本效益的患者福利。这项研究将比较提供者提供的护理管理(PDCM)和健康计划提供的护理管理(HPDCM)；试图确定这两种方法在患者参与护理管理、临床相关的健康指标和卫生保健利用方面的比较有效性。

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.