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

描述（由申请人提供）：2011年HHS关于多种慢性疾病的报告强调了与身体和精神共同发生的慢性疾病相关的患病率，发病率和成本。协作慢性护理模式（CCMs）在治疗慢性医学和精神疾病方面非常有效，而且几乎没有净医疗成本。迄今为止，ccm主要在设施级别实施，并被大型公共医疗保健组织采用。然而，绝大多数提供商业保险护理的初级保健和行为健康实践规模太小，无法实施这种模式。卫生计划级别的共同承诺机制可以解决这一未满足的需求。基于与Aetna公司的开创性合作，本研究的目标是实施一种交叉诊断CCM，旨在改善情绪障碍患者的预后，并着眼于为个人或小型实践开发一种可推广的计划级CCM的商业案例。情绪障碍（抑郁症和双相情感障碍）被Aetna确定为优先条件，因为它们的慢性性质和高昂的医疗费用。虽然基于证据的护理参数已经很好地建立起来，但对于情绪障碍患者来说，医疗和精神护理的质量和健康结果并不理想。我们将在全国范围内因单极抑郁症或双相情感障碍住院并在单独或小型初级保健或行为健康实践中接受治疗的Aetna受益人中进行交叉诊断CCM与教育控制的随机对照试验。在住院出院时，共有172个单独或小型诊所，涉及344名患者，将被随机分配到一年的门诊治疗，增加CCM或教育控制。CCM的组成部分包括由盐湖城的Aetna护理管理中心实施的完全远离实践场所和患者的护理管理、提供者指南支持和基于网络的自我管理支持（Life Goals program）。主要的健康结果是情绪障碍症状、健康相关的生活质量、住院治疗以及基于指南的情绪障碍和心脏代谢管理。次要结果包括确定与CCM结果和吸收相关的提供商和组织因素，包括医疗IT能力、与教育控制相比CCM的成本效益，以及根据经验数据和利益相关者的输入制定业务计划。本建议的R18解决了AHRQ的研究示范和传播重点，特别是围绕预防和护理管理。除了这种开创性的实践-研究合作关系，专注于单独或小型实践，以进一步在健康计划层面实施ccm，本研究还可能导致跨诊断ccm的商业案例的发展，以及计划级小组管理和远程电子医疗技术的应用，特别是随着负责任的医疗组织和类似举措的出现。

DESCRIPTION (provided by applicant): 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.