RESUMO
Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target "high-need, high-cost" patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.
Assuntos
Atenção à Saúde/economia , Atenção à Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Administração dos Cuidados ao Paciente/economia , Avaliação de Programas e Projetos de Saúde , Organizações de Assistência Responsáveis , Terapia Comportamental , Doença Crônica , Comorbidade , Controle de Custos/métodos , Humanos , Avaliação das Necessidades , Melhoria de Qualidade , Fatores Socioeconômicos , Estados UnidosRESUMO
Of the many innovations in health care delivery proposed in the context of health reform for those with chronic diseases such as diabetes, the group visit model is relatively easy to implement and is effective for improving health outcomes and patient and provider satisfaction, with a neutral to positive effect on health care costs. This article describes the evolution of group visits for those with diabetes, the theory underlying group visits for patients with chronic medical conditions, and the existing evidence for the effectiveness of this model. It also addresses implementation of groups in practice, with an emphasis on the practical aspects of program implementation, integration of behavioral expertise into medical groups, individualization in various practice settings, and reimbursement issues.