title: A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes.
abstract: The real world implementation of chronic care management model varies greatly. One aspect of this variation is the delivery mode. Two contrasting strategies include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM).
  
  
  
  We aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases.
  
  
  
  We used a quasi-experimental two-group pre-post design using the difference-in-differences method.
  
  
  
  Commercially insured patients, with any of the five chronic diseases-congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes, or asthma, who were outreached to and engaged in either PDCM or HPDCM were included in the study.
  
  
  
  Outreached patients were those who received an attempted or actual contact for enrollment in care management; and engaged patients were those who had one or more care management sessions/encounters with a care manager. Effectiveness measures included blood pressure, low density lipoprotein (LDL), weight loss, and hemoglobin A1c (for diabetic patients only). Primary endpoints were evaluated in the first year of follow-up.
  
  
  
  A total of 4,000 patients were clustered in 165 practices (31 in PDCM and 134 in HPDCM). The PDCM approach demonstrated a statistically significant improvement in the proportion of outreached patients whose LDL was under control: the proportion of patients with LDL < 100 mg/dL increased by 3 % for the PDCM group (95 % CI: 1 % to 6 %) and 1 % for the HPDCM group (95 % CI: -2 % to 5 %). However, the 2 % difference in these improvements was not statistically significant (95 % CI: -2 % to 6 %). The HPDCM approach showed 3 % [95 % CI: 2 % to 6 %] improvement in overall diabetes care among outreached patients and significant reduction in obesity rates compared to PDCM (4 %, 95 % CI: 0.3 % to 8 %).
  
  
  
  Both care management delivery modes may be viable options for improving care for patients with chronic diseases. In this commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year. Different care management strategies within the provider-delivered programs need further investigation.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA. zluo@msu.edu.
authors.forename: Zhehui
authors.initials: Z
authors.lastname: Luo
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Sourthen California, Pasadena, CA, USA.
authors.forename: Qiaoling
authors.initials: Q
authors.lastname: Chen
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Annis
authors.affiliation: Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Piatt
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Green
authors.affiliation: Clinical Epidemiology and Biostatistics, Blue Cross Blue Shield of Michigan, Detroit, MI, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Tao
authors.affiliation: Department of Family Medicine, University of Colorado , Aurora, CO, USA.
authors.forename: Jodi Summers
authors.initials: JS
authors.lastname: Holtrop
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D000073278:Self-Management
keywords: care management; chronic Disease; comparative effectiveness; primary Care