Health and Disability

In the Commonwealth Fund report, Hong and his co-authors - Timothy Ferris, MD, MPH, vice president, Population Health Management, at MGH and Partners HealthCare System and Allison Siegel, MPH, formerly with the Stoeckle Center for Primary Care Innovation at MGH - review characteristics of successful care management programs. Foremost among these are close collaboration of care managers with all the providers taking care of a complex patient. They note that small, one- and two-physician primary care practices may lack the resources required for complex care management. In cases like that, regional organizations - either public or private - can provide the infrastructure for care management that remains closely tied to patients' known providers.

In the NEJM article, Hong, Ferris and Melinda Abrams, vice president, Delivery System Reform, at the Commonwealth Fund note that the primary barrier to broader adoption of care management is the fee-for-service payment system, which provides little or no support for essential care management functions. Instead, reimbursement systems that provide global payments covering all services a complex patient requires or those that share cost savings among both payers and providers may be better options. Another option that provides a monthly, per-patient care management fee might encourage the participation of providers unable to take on the financial risks involved in global payment contracts. Other barriers include the start-up costs associated with staff training and new information technology, which could be covered by supplemental payments. Unrealistic expectations for a rapid return on investment could be addressed by increasing the duration of payer-provider contracts.