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Slide Presentation from the AHRQ 2007 Annual Conference

This is the text version of the slide presentation titled Addressing Problems in Care Coordination: Experience of Care Management Plus.

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Addressing Problems in Care Coordination: Experience of Care Management Plus

Addressing Problems in Care Coordination: Experience of Care Management Plus
The Care Management Plus Team
Case study
Ms. Viera and her caregiver come to clinic with several problems, including
Ms. Viera's office visit
What do we know?
Care Management Plus fills in core gaps in many clinics through a proactive, flexible system.
Care Coordination and Care Management
Care Management Plus can help create a medical home.
Picture of Patient Worksheet
Population Tickler
What was the effect of CMP on patient outcomes?
Guideline Adherence in Diabetes: Results
Odds of dying were reduced significantly.
Odds of admission (any cause) were reduced by 27-40% for patients with complex diabetes.
Care Management Plus has other benefits... quality and efficiency
Problems in creating Care Coordination
Variability of results across programs and populations
Reliability: Lack of a framework for describing differences
Reimbursement and Cost Neutrality
Steps to Implementation—JAHF funded dissemination grant
Thank you!
Care management varies by intensity and function for different populations and needs.
Description as 'dosage'
Physicians were more efficient through better documentation, a slight increase in visits, and a change in practice pattern.
Screenshot