Chronic Care Management Programs Have Become Standard for Health Plans

Programs to help patients manage chronic diseases such as diabetes and asthma appear to have become a standard component of health plans, according to a new RAND Corporation study.

"The number of people in the United States with one or more chronic conditions is expected to grow to 171 million by 2030, which means almost one in two Americans will suffer from a chronic disease in the not-too-distant future," said Soeren Mattke, the study's lead author and managing director of RAND Health Advisory Services. "There is an urgent need to improve management of chronic conditions."

Researchers collected information from a nationally representative sample of health plans to understand the current range of chronic care management services for commercially insured patients, to document how programs engage with patients and providers and to elicit emerging industry trends.

The 25 health plans surveyed were randomly selected and represented a broad range of sizes, locations and ownership models. In addition to telephone surveys, six health plans were chosen for in-depth case studies that involved one- to two-day site visits.

Published in the latest edition of the American Journal of Managed Care, the study found that all plans, regardless of size, location, and ownership, offer programs to support members with chronic conditions. Plans typically identify those members based on claims and laboratory data, and then match them to appropriate interventions and resources based on need and risk.

While internal evaluations suggest that these programs improve care and reduce cost, plans report difficulties in engaging members and providers, leading to the programs being underutilized.

To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies.

The findings suggest health plans are in the process of changing their approach to chronic care management, moving toward integrating information from electronic medical records and embedding health plan staff into medical practices. Most of the case study plans are looking to adopt patient-centered medical home models to provide better continuity of care.

Support for the study was provided by AHIP Foundation. Other authors of the study are Aparna Higgins of American's Health Insurance Plans and Robert Brook of RAND.

RAND Health Advisory Services develops meaningful, innovative, and practical solutions for companies and associations that navigate the evolving health care environment — particularly the transition from "pay-for-volume" to "pay-for-value." RAND Health Advisory Services leverages the vast expertise of RAND Health, the world's largest independent health policy research organization. RAND Health is a division of the RAND Corporation, a nonprofit research organization.