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Complex Puzzle: How Payers Are Managing Complex and Chronic Care

Susan Philip and Sophie Miller, Booz Allen Hamilton

Chronic diseases and the cost of care are rising. Are disease management programs improving outcomes for patients with complex, chronic conditions?

With the increasing prevalence and associated cost of chronic diseases in the US, health care stakeholders, including payers, are looking for ways to better manage the care of patients with these conditions. Payers use disease management (DM) programs for members with common chronic diseases, and complex case management (CCM) programs for patients with more complex conditions.

Public and private payer representatives were surveyed to learn how they arrange for DM and CCM programs, design them to target and engage members, and evaluate their impact. This issue brief summarizes the study findings and discusses how health reform is affecting these programs.

Highlights of considerations outlined in the issue brief:

  • Using analytic tools will help payers to better identify the population that would most benefit from programmatic interventions.
  • Payers might benefit from experimenting with a wide range of patient outreach and engagement tools, including mobile applications, text messaging, and in-person coaching.
  • Health reform provides opportunities for payers to better integrate DM and CCM programs into providers' practices.

Despite mixed success in the ability of DM and CCM programs to bend the cost curve and to improve outcomes, payers and public and private purchasers agree that fragmented and uncoordinated care is not an option.

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