Goldman L Elizabeth, Handley Margaret, Rundall Thomas G, Schillinger Dean
University of California Department of Medicine, San Francisco, CA 94143, USA.
Am J Manag Care. 2007 May;13(5):263-8.
To determine the extent to which Medicaid managed care (MMC) organizations are engaged in chronic disease care management (CDCM), tailor CDCM for diverse populations, or plan to expand CDCM.
Web-based survey of 23 eligible California MMC health plan executives in fall 2005.
Frequency distributions of survey responses.
Nineteen (83%) of 23 executives responded, representing 2.5 million beneficiaries. Eighteen (95%) MMC plans reported implementing 1 or more elements of CDCM. Although plans used a wide range of CDCM strategies to reach performance goals, most implemented provider awareness activities such as offering guidelines or disease-specific feedback to physician groups. More than half of the plans reported interest in expanding CDCM to include more active interventions such as disease registries, pay for performance, telephone counseling to patients, and other self-management support programs. Few plans reported tailoring their CDCM to vulnerable member populations such as those with limited literacy or limited English proficiency. Executives reported that insufficient financial resources at the plan level, lack of organizational leadership and commitment in physician organizations, and limited information technology in physician offices were barriers to CDCM expansion.
California MMC health plans reported substantial interest in CDCM and a desire to increase CDCM. Representatives reported intentions to expand to strategies that more directly engage providers and patients. To ensure that the growing number of vulnerable enrollees with chronic disease receive high-quality care, policy efforts should focus on enabling MMC health plans to more consistently implement and target population-based strategies such as CDCM.
确定医疗补助管理式医疗（MMC）组织在多大程度上参与慢性病护理管理（CDCM）、为不同人群量身定制CDCM或计划扩大CDCM。
2005年秋季对23名符合条件的加利福尼亚MMC健康计划高管进行基于网络的调查。
调查回复的频率分布。
23名高管中有19名（83%）回复，代表250万受益人。18个（95%）MMC计划报告实施了CDCM的1项或多项要素。尽管各计划采用了广泛的CDCM策略来实现绩效目标，但大多数计划实施了提供者意识提升活动，如向医生群体提供指南或特定疾病反馈。超过一半的计划表示有兴趣扩大CDCM，纳入更积极的干预措施，如疾病登记、按绩效付费、给患者的电话咨询以及其他自我管理支持项目。很少有计划报告为识字能力有限或英语水平有限等弱势成员群体量身定制CDCM。高管们报告称，计划层面资金不足、医生组织缺乏组织领导力和承诺以及医生办公室信息技术有限是CDCM扩展的障碍。
加利福尼亚MMC健康计划报告对CDCM有浓厚兴趣并希望增加CDCM。代表们表示有意扩展到能更直接让提供者和患者参与的策略。为确保越来越多患有慢性病的弱势参保者获得高质量护理，政策努力应聚焦于使MMC健康计划更持续地实施并针对基于人群的策略，如CDCM。
