The current fee-for-service payment model does not generally reimburse practices for the CM and coordination services required to oversee panels of heterogeneous patients, many of whom have increasingly complex and comorbid conditions. It presents practice and policy recommendations for the provision of CM services and highlights three key strategies to enhance CM for target populations: (1) identify population(s) with modifiable risks (2) align CM services to the needs of the population(s) and (3) identify, prepare, and integrate appropriate personnel to deliver the needed services.ĭespite the rapid and widespread adoption of CM, questions remain about the best way to optimize and pay for the mix of staff and services involved in its delivery.
This issue brief was informed by the experience of the AHRQ grantees (including reports from the Annals of Family Medicine special issue on the Transforming Primary Care grants), 5-16 our own process of primary care practice transformation, and the CM literature more broadly. Findings confirmed the importance of establishing CM services appropriate to the clinic context as well as the population served. They also identified shared themes and provided case studies. 4 Participants provided a brief summary of the study context, available data sources, and lessons learned. A subgroup of 12 investigators conducted a narrative synthesis of experiences developing CM programs within different clinical, geographical, and administrative contexts. These 18 projects explored ways to more effectively and efficiently deliver primary care in various practice contexts (e.g., urban/rural and large/small practices).Īims among these funded grants included the investigation of successful strategies for the implementation and practice of CM. In 2010, AHRQ funded 14 Transforming Primary Care grants and supported four additional Delivery System Research grants through American Recovery and Reinvestment Act funding. The CM recommendations presented in this brief emerged from recent research funded by AHRQ on primary care practice transformation. Care management is a promising team-based, patient-centered approach “designed to assist patients and their support systems in managing medical conditions more effectively.” 3 It also encompasses those care coordination activities needed to help manage chronic illness. Unlike case management, which tends to be disease-centric and administered by health plans, 2 CM is organized around the precept that appropriate interventions for individuals within a given population will reduce health risks and decrease the cost of care. Care management has emerged as a primary means of managing the health of a defined population. In order to achieve the triple aim, health care delivery systems throughout the country are working to effectively treat patient populations, while at the same time decreasing health risks and health care costs. Care Management: a Fundamental Vehicle for Managing the Health of Populations Overview
Key strategies and recommendations are listed in the Exhibit and discussed in more detail in the body of this issue brief. The brief's recommendations were informed by 14 Transforming Primary Care grants and 4 Delivery System Research grants, all funded by the Agency for Healthcare Research and Quality (AHRQ). This brief summarizes recommendations for decisionmakers in practice and policy, as well as for future research. This issue brief highlights three key strategies to enhance existing or emerging CM programs: (1) identify population(s) with modifiable risks (2) align CM services to the needs of the population(s) and (3) identify, prepare, and integrate appropriate personnel to deliver the needed services. Care management (CM) has emerged as a leading practice-based strategy for managing the health of populations. 1 Understanding and effectively managing population health is central to each of the aim’s three elements. Health care delivery systems throughout the United States are employing the triple aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care) as a framework to transform health care delivery.
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