Williams Mark D, Asiedu Gladys B, Finnie Dawn, Neely Claire, Egginton Jason, Finney Rutten Lila J, Jacobson Robert M
Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Institute for Clinical Systems Improvement, Minneapolis, MN, USA.
BMC Health Serv Res. 2019 Feb 1;19(1):92. doi: 10.1186/s12913-019-3916-5.
Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota.
We used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach.
We identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes.
Primary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service.
护理协调一直是寻求管理复杂患者的医疗机构常用的工具，但对于最有效和可持续的模式仍存在困惑。关于护理协调提供者的意见已有研究，但关于保险行业人员对关键要素看法的信息有限。我们试图收集明尼苏达州参与医疗保险和医疗补助服务中心（CMS）转型拨款项目的初级保健提供者和管理人员的意见，该项目实施COMPASS（精神、身体和物质使用综合征护理），这是一种针对患有糖尿病和/或心血管疾病的抑郁症患者的循证护理协调模式。然后，我们试图将这些观点与明尼苏达州的私人保险代表的观点进行比较。
我们采用定性方法，对初级保健提供者（n = 15）、管理人员（n = 15）和保险公司（n = 12）进行了42次关键信息提供者访谈。我们使用框架分析方法对记录和转录的数据进行分析，一旦去除身份识别信息。
我们确定了六个主要主题：1）建立综合护理协调项目的明确范围、基本原理和关键伙伴关系，2）有效的信息交流，3）经过培训且可随时提供服务的劳动力，4）需要商业模式和财务上合理的项目，5）需要对护理协调进行评估和持续改进，6）患者和家庭参与的重要性。各利益相关者群体的总体共识很高，包括呼吁进行支付改革以支持一项有价值的服务。尽管保险代表在支付护理费用方面发挥着作用，但他们并没有强调降低利用率比其他结果更重要。
来自不同组织和背景、都有COMPASS经验的初级保健提供者和管理人员，在很大程度上与保险代表就可持续模式的主要要素以及进行医疗改革以维持这项服务的必要性达成了一致。
