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The need for better management of chronic conditions is urgent. About 141 million people in the United States were living with one or more chronic conditions in 2010, and this number is projected to increase to 171 million by 2030. To address this challenge, many health plans have piloted and rolled out innovative approaches to improving care for their members with chronic conditions. This report documents the current range of chronic care management services, identifies best practices and industry trends, and examines factors in the plans' operating environment that limit their ability to optimize chronic care programs. The authors conducted telephone surveys with a representative sample of health plans and made in-depth case studies of six plans. All plans in the sample provide a wide range of products and services around chronic care, including wellness/lifestyle management programs for healthy members, disease management for members with common chronic conditions, and case management for high-risk members regardless of their underlying condition. Health plans view these programs as a "win-win" situation and believe that they improve care for their most vulnerable members and reduce cost of coverage. Plans are making their existing programs more patient-centric and are integrating disease and case management, and sometimes lifestyle management and behavioral health, into a consolidated chronic care management program, believing that this will increase patient engagement and prevent duplication of services and missed opportunities.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Program Prevalence

  • Chapter Three

    Program Design

  • Chapter Four

    Member Interaction

  • Chapter Five

    Coordinating Plan and Provider Activities

  • Chapter Six

    Chronic Care Management Program Evaluation

  • Chapter Seven

    Challenges To Chronic Care Management Program Success

  • Chapter Eight

    Conclusions

  • Appendix A

    Detailed Results from Survey

  • Appendix B

    Case Studies

The research described in this report was sponsored by the America's Health Insurance Plans Foundation, and was produced within RAND Health, a division of the RAND Corporation.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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