Medical Care blog

Comments from the scientific community regarding Medical Care.

Thursday, February 26, 2015

Coordinated care is more than just a buzzword

by Damika W. Barr, J.D.

Ask health policy professionals for solutions to improve health outcomes for those with chronic disorders, and coordinated care will be offered as a solution because well, coordinated care is one of many buzzwords used in current health reform conversations.  But is it more than just a buzzword? I think so.  This is my third blog of published recent research in the Medical Care Journal; each demonstrating successful outcomes utilizing a coordinated care program over traditional treatment options for chronic conditions.

First, I blogged about a research team that explored the differences in clinical outcomes for non-Latino White, non-Latino Black and Latino individuals with complex and co-occurring chronic health conditions participating in Care Management Plus (CMP) interventions at six clinics in Oregon and Northern California from 2009 to 2011. The results showed that while CMP programs are not necessarily geared towards an equitable result, preliminarily it appears that the program provides positive health outcomes for complex care patients regardless of race/ethnic background.

Next, I likened coordinated care to an actor’s entourage describing research that demonstrated how Collaborative Care Management can reduce racial disparities shown in seeking treatment and medication adherence for depression disorders.
Published in the February issue of the Medical Care Journal is additional support for the benefits of coordinated care. Chris Beadles and team are comparing medication adherence for Medicaid recipients with multiple chronic conditions enrolled in a coordinated care model versus recipients enrolled in traditional fee for service plans. The focus on Medicaid recipients is important because previous studies have observed that medication adherence is generally lower in this group.

Community Care of North Carolina serves the state’s Medicaid population through primary care case management. The care coordination model consists of 14 regional networks of primary care providers, which connect Medicaid participants to primary care medical homes.  All the medical homes provide a population management tool, evidence-based programs and protocols, disease management, pharmacy management, case management, and regular reports of disease-specific performance metrics.  With these processes in place, the outcomes should be improved quality of care, more encounters, fewer hospitals visits, and greater medication adherence.

The research team focused on medication adherence by selecting four conditions typically managed in a primary care setting, major depressive disorder, hypertension, diabetes mellitus, and hyperlipidemia and compared the proportion of days covered for Medicaid recipients in CCNC verses those in fee for service plans.  A retrospective review of prescription claims determined the proportion of days in a month the medication was available to a patient. A patient was considered exposed to a given treatment if medication was available on the day observed. A patient was considered to be actively participating in CCNC if the monthly management fee appeared in claims for the primary care provider and CCNC network.

Across all observed disorders, the medical home enrollees had higher proportion of days covered over the 19 month observation period than non-medical home enrollees. While the researchers caution that the clinical significance is still unknown, it is more proof that coordinated care may not just be a buzzword.

Read the full article here to learn more about the patient sample, methods, limitations, and future research needs.

Damika Barr is a Senior Health Policy Analyst at AmeriHealth Caritas. The views expressed on this post are those of the author and do not necessarily reflect the views of AmeriHealth Caritas.