An Evaluation of a Payer-Operated Chronic Disease Care Management Program

Abstract

The burden of chronic diseases and a fragmented healthcare system are associated with excessive healthcare costs. Policy makers, payers, and providers are intervening through system redesign efforts to support patients in curbing costs. Care management, a widely recognized intervention, uses trained clinical providers to support patients with complex needs such as multiple co-morbidities to develop care plans, written document of medical and behavioral targets agreed upon by providers and patients. Care management programs are heterogenous and complex. Evaluations and research measure varied metrics and these metrics differ in effectiveness. The Doctorate in Public Health Candidate’s Doctoral Engagement in Leadership and Translation for Action (DELTA) project evaluated one payer operated care management program using path analysis. The evaluation specifically assessed the effects of achieving goals identified in the care plan. The evaluation included 9,866 members in care management between 2015-2016. Findings suggest that reaching the behavioral and medical targets in the care plan is associated with reduction in cost after beginning the program. On average, reaching targets reduced cost by $437 per member per month. Weekly encounters increased likelihood of reaching those targets though primary care physicians engagement had lower than expected effects. The program could support PCPs to better engage members to reach their care plan targets. Further research and evaluation should be done to understand why members leave the program before reaching all their targets, to analyze changes in healthcare utilization, and to explore the use of vendor-operated innovative technologies that may improve services.