title: Comparison of provider and plan-based targeting strategies for disease management.
abstract: OBJECTIVE
  We aimed to describe and contrast the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program.
  
  
  METHODS
  Health plan epidemiologists partnered with university health services researchers to conduct a quasi-experimental, mixed-methods study of a 2-year pilot. We used semi-structured interviews to assess the characteristics of program-targeting strategies, and calculated target and engagement rates from clinical encounter data.
  
  
  METHODS
  Five physician organizations (POs) with 51 participating practices implemented care management. Health plan member lists were sent monthly to the practices to accept patients, and then the practices sent back data reports regarding targeting and engagement in care management. Among patients accepted by the POs, we compared those who were targeted and engaged by POs with those who met health plan targeting criteria.
  
  
  RESULTS
  The health plan's targeting process combined claims algorithms and employer group preferences to identify candidates for disease management; on the other hand, several different factors influenced PO practices' targeting approaches, including clinical and personal knowledge of the patients, health assessment information, and availability of disease-relevant programs. Practices targeted a higher percentage of patients for care management than the health plan (38% vs 16%), where only 7% of these patients met the targeting criteria of both. Practices engaged a higher percentage of their targeted patients than the health plan (50% vs 13%).
  
  
  CONCLUSIONS
  The health plan's claims-driven targeting approach and the clinically based strategies of practices both provide advantages; an optimal model may be to combine the strengths of each approach to maximize benefits in care management.
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd, Bldg 16 NCRC, Ann Arbor, MI 48109. E-mail: aannis@ umich.edu.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Annis
authors.forename: Jodi Summers
authors.initials: JS
authors.lastname: Holtrop
authors.forename: Min
authors.initials: M
authors.lastname: Tao
authors.forename: Hsiu-Ching
authors.initials: HC
authors.lastname: Chang
authors.forename: Zhehui
authors.initials: Z
authors.lastname: Luo
mesh_terms: D019468:Disease Management; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors