Chronic care management facing uphill battle
Health plans encounter challenges engaging patients and providers in improving care
Thanks in part to the growing prevalence of chronic disease among American adults, more and more commercial health plans are introducing chronic care management programs. However, the effectiveness of these programs has been hindered by limited patient engagement and the reluctance of doctors to change the way they practice, according to a recent study.
The study, published in The American Journal of Managed Care examined the chronic care management programs of 25 health plans with commercial enrollment of 50,000 or more members. It found similarities in the overall structure of the programs, but differences in the way plans identified members who might need chronic care management, as well as how they matched interventions and resources to patients’ needs and risks.
Nearly half (42%) of the plans studied reported “substantial challenges” to recruiting members to use chronic care management services. Challenges included missing or invalid contact information or members simply not responding to attempts to reach them.
Related: Chronic care management success
Among members who do participate in a chronic care management program, the most common obstacles to improving care are limited patient engagement (cited by 83% of plans), health literacy (67%) and patient readiness to change (58%). In response, nearly half of the plans report using some form of incentive—such as gift cared, or lowering cost-sharing requirements or premiums—to get patients more engaged.
On the provider side, 67% of the plans cited limited provider staff resources and lack of patient registries and electronic health records as barriers to effective chronic care management. In addition, 63% said that “provider reluctance to change” hampered efforts at better chronic care management, with “many providers preferring to focus on their traditional encounter-based approach as opposed to population management.” Thirty-eight percent of the plans said coordination with providers was the most important factor in making chronic care management plans work.