QUESTIONS AND ANSWERS ABOUT CHRONIC CARE MANAGEMENT & WELLNESS

1. What exactly is "chronic care management?"

Chronic care management is a system of coordinated health care interventions and communications for populations with chronic conditions in which patients' self-care is important to managing the disease.

Chronic care management supports the physician or practitioner/patient relationship and plan of care; emphasizes prevention of complications; utilizes evidence-based practice guidelines; and evaluates outcomes on an on-going basis with the goal of improving overall health. 

Components of chronic care management include collaborative practice models to include physician and support-service providers, patient self-management education, and process and outcomes measurement, evaluation, and management.

2. Does chronic care management really save money?

Chronic care management shows promise in addressing rising costs driven by the growing incidence of chronic disease, while still increasing quality and protecting health care access.

For example, a chronic care management program for Florida Medicaid beneficiaries with congestive heart failure reduced health care expenditures over a two-year period by 16.3 percent.   This resulted in net savings to the state of $4.4 million for an average of 2,500 beneficiaries.  

In the past, some studies of chronic care management have had difficulty quantifying direct cost savings.  To address this, the Care Continuum Alliance released guidelines in September 2007 of recommended practices for measuring outcomes in chronic disease management programs.  With the guidelines, chronic care management advocates hope to demonstrate the clinical and financial outcomes of chronic care management programs.

3. How do chronic care management programs affect health outcomes for those with chronic illnesses?

Medical scholars are looking to chronic care management as an essential tool to improve health care outcomes for those with chronic illnesses. A 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm: A New Health System for the 21st Century, was a virtual blueprint for chronic care management. It said the flaws in the current system of health care delivery argue for sophisticated mechanisms to coordinate care, particularly for the chronically ill.  

The states have been the earliest adopters of chronic care management programs and thus have the most data as to chronic care management's success in improving health outcomes. One of the oldest programs, based in Florida, has documented success in generating improvements in care quality and patient satisfaction as well as in reducing certain process outcomes such as emergency room visits, hospital inpatient visits, hospital lengths of stay, and re-hospitalizations.

Other states and the ongoing federal demonstration projects are also achieving results, but it is too early to evaluate quality improvements in a comprehensive way.