Provider and Plan Care Management Programs

Care and disease management programs and tools are ubiquitous.  A study in the Journal of General Internal Medicine considers whether ones directed by health plans or providers have greater success, if any.  (JGIM Article)   In theory, provider-operated disease management might have more success, since it is inherently integrated with primary care.  The study compared in one health plan over 2010 to 2012, disease management programs operated by the plan’s staff for congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes and asthma, versus those operated by four physician groups consisting of 31 primary care practices and funded by the health plan.  The programs did not have identical features, but were broadly similar.  A pre-post design was used to analyze impacts.  Outcomes included cholesterol levels, weight management, blood pressure, and blood sugar control.  Data from around 4000 patients was included in the analysis.  There was modest improvement in most outcome measures for both groups.  The provider-directed care management programs did somewhat better on some measures and the health plan programs did somewhat better on others, but none of the differences reached statistical significance.  Both programs accomplished getting some additional patients engaged in a program.  Many of the patients, although suffering from one of the chronic diseases, already had outcome measures that were within goals, making further improvement difficult.  There was a savings in overall health expenditures among both groups, but these savings were not compared to the costs of the programs.  The general lack of substantial improvement in outcome measures is not encouraging for disease management programs generally, and is consistent with some other research, but it is good to find that both health plan and provider-operated disease management programs appear to have some effectiveness.