Access to Care

California Medicaid managed care plans would like to increase chronic disease care management programs

Chronic disease care management (CDCM) programs for low-income vulnerable populations will be critical to providing quality care, as States continue to enroll disabled beneficiaries, many with chronic illnesses, into Medicaid managed care (MMC) plans. California MMC health plans are very interested in CDCM and would like to increase these programs, concludes a new study.

The researchers conducted a Web-based survey of 23 eligible California MMC health plan executives in 2005. Nineteen executives, representing 2.5 million Medi-Cal beneficiaries, responded to the survey.

Overall, 95 percent of MMC plans had implemented one or more elements of CDCM. Most implemented provider awareness activities such as offering clinical guidelines or disease-specific feedback to physician groups.

More than half of the plans were interested in expanding CDCM to include more active interventions such as disease registries; pay for performance; proactive, automated telephone counseling services; and other self-management support programs. A number of MMC plans also used mailed patient reminders (95 percent) and disease self-management support programs (53 percent) and connected patients to community resources (47 percent).

Although most plans targeted CDCM strategies for diabetes (84 percent) and asthma (100 percent), few of them targeted CDCM strategies for congestive heart failure (21 percent), coronary artery disease (21 percent), or depression (21 percent). Also, few plans tailored their CDCM to vulnerable groups such as those with limited literacy or limited English proficiency. The most commonly cited barriers to expanding CDCM faced by MMC plans were prohibitive cost, absence of physician leadership support, and lack of information technology in physician offices.

The study was supported in part by the Agency for Healthcare Research and Quality (HS14864).

See "Current and future directions in Medi-Cal chronic disease care management: A view from the top," by L. Elizabeth Goldman, M.D., M.C.R., Margaret Handley, Ph.D., Thomas G. Rundall, Ph.D., and Dean Schillinger, M.D., in the May 2007 American Journal of Managed Care 13(5), pp. 263-268.

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