Care Management Theories versus Realities in Health Care

ABSTRACT

Mixed evidence of care management effectiveness raises questions about how these services are provided in practice. This study evaluates care management in nine provider settings using elements from two prominent models: The Chronic Care Model and the Care Transitions Program. Staff interviews addressed organizational and community resources. Patients were also surveyed about their experiences. Patients generally indicated actively managing their own care. However, patient interactions with care managers generally fell below recommended levels. This study suggests a need to examine the quantity of specific elements of care management that yield desired outcomes, such as improved disease self-management and health.

KEYWORDS:

• Care management
• case management
• care transitions
• chronic conditions
• implementation

Acknowledgments

The authors thank our partners at the Texas Health and Human Services Commission for their guidance on this study, as well as all of the study participants for taking their time to share their experiences.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Texas Health and Human Services Commission and Centers for Medicare and Medicaid Services, project #11-W-00278/6. The findings are those of the authors and do not necessarily represent the official position of the agencies.