May 26, 2015
Published in: American Journal of Managed Care, v. 21, no. 5, May 2015, p. 370-376
Posted on RAND.org on January 26, 2016
OBJECTIVES: The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (i.e. in products sold to employers and individuals). STUDY DESIGN AND METHODS: We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. RESULTS: All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. CONCLUSIONS: Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.