Building a bit on a post earlier this week on high-cost patients and the persistence of their spending, for many years experts have recognized the importance of identifying and managing the care of patients with complex medical conditions. Several models or programs have been created for this purpose, including a variety of disease and more generalized care management efforts. A Commonwealth Fund report assesses the evidence for effectiveness of these programs. (Commonwealth Brief) The report is basically a meta-review of meta-reviews over the years on these intensive care management models. As those reviews found, there is limited evidence for either lowered spending (net or gross of program costs) and for better health outcomes. What this report adds is an attempt to sift the programs by feature and by population and condition addressed and see if there are particular features that seem connected to better outcomes.
And what you are left with is pretty much common sense. The features of the program that seem to be most linked to success include: targeting patients most likely to benefit from an intervention; a comprehensive assessment of the patients needs and resources; an evidence-based care plan and ongoing regular patient monitoring; encouraging patients to engage in self-care and management; facilitation of care transitions, especially from acute or post-acute care to home and community resources; and appropriate care in accordance with patient goals and priorities. And in terms of the execution of the program attributes linked to success were: interdisciplinary teamwork; trained care managers that build face-to-face rapport with patients and who work well with the patient’s providers; coaching and use of behavior change techniques to encourage patient self-care; use of health IT for data, analytics, and communication; and measurement of outcomes with a goal toward improving care plans. Like I said, just common sense. So why isn’t there more success? Probably because designing things is always easier that actually executing them well.