Cassirer C, Reardon GT, Dale D, Clarke RW, Bringewatt RJ; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 300.
Healthcare Risk Services Group, MMI Companies, Inc., Deerfield, IL 60015, USA.
RESEARCH OBJECTIVE: To describe variation in the models and approaches to providing chronic care management among integrated delivery systems as well as present "better practices" and lessons learned. STUDY DESIGN: A multiple-embedded case study design (Yin, 1995) is employed to test the hypothesis that there is variation in strategy, structures, processes, and performance measurement systems in place among integrated delivery systems' developing chronic care management programs. A two stage sampling methodology was employed to identify potential cases study sites. First, a telephone survey was completed with 34 (96%) health systems who are members of the National Chronic Care Consortium as of 1997. From this initial sample, seven health systems were selected for in-depth case study analysis and varied by size, location, ownership, competition, health plan ownership and identification by peers as having a successful integrated care management program. A research team comprised of 3-5 investigators conducted two day, on-site, semi-structured, key informant interviews with six health systems and telephone interviews with the seventh system. A modified snowball technique was used to identify key informants at each site. One hour interviews were conducted with ten to twenty informants from each site including: board members, senior executives, senior clinical leaders and administrators, physicians, nurses, social workers, case managers and other members of patient care teams. Interview questions focused on the history and development of the chronic care services, leadership, strategy, structures, processes, and performance measurement systems in place to support service development and ongoing evaluations, barriers and facilitators of success, "better practices" and lessons learned. PRINCIPAL FINDINGS: Comparative case studies reveal there is variation in the models and approaches in place among integrated delivery systems to provide chronic care management services. Characteristics of successful models and approaches vary depending on the degree of system integration along three dimensions: functional, physician, and clinical (Shortell et al., 1996). Performance measurement systems in place vary depending on the degree of health system integration, resources, and market place factors. Barriers and facilitators of program growth vary and include market characteristics, dominant payers, leadership issues, degree of system integration, among other factors. CONCLUSIONS: There does not appear to be one best way or "best practice" model that fits with the complex strategic challenges and opportunities affecting health systems in different markets. Therefore, a range of models and approaches are described, along with their associated barriers, facilitators, "better practices" and lessons learned. Similar characteristics of successful programs, however, include physician support and involvement in services development early on is considered key. Senior leadership commitment and information technology infrastructure are critical elements. Care providers must adopt systems thinking and develop a range of demand management and case management strategies to link, coordinate, manage and measure care provided. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: These preliminary findings are the first empirical research describing variation in approaches to developing chronic care management programs among integrated delivery systems. The study of chronic care management initiatives is an important prism through which to view the process of health system integration. Early in the 1990s, many pursued a strategy of integration and began to develop chronic care management programs. The U.S. health care system, however, has not changes as quickly as most systems anticipated. Tightening constraints on revenues, differences in managed care penetration, lack of sufficient infrastructure support to promote both integration and chronic care management program development are important ongoing concerns for systems. In addition, many systems are struggling with issues of leadership, directional and positioning strategies. This study presents a range of "better practices" and lessons learned from health systems in different markets with different models for providing chronic care services. Policy makers and managers will benefit from a presentation and substantive review of the models and approaches to providing chronic care management and associated "better practices" from the perspective of health systems.
Publication Types:
Keywords:
- Case Management
- Data Collection
- Delivery of Health Care
- Delivery of Health Care, Integrated
- Humans
- Interviews as Topic
- Leadership
- Long-Term Care
- Managed Care Programs
- Medical Records Systems, Computerized
- Models, Biological
- Physicians
- Program Development
- Research
- Systems Integration
- United States
- economics
- methods
- hsrmtgs
Other ID:
UI: 102194604
From Meeting Abstracts