Journal of General Internal Medicine

, Volume 33, Issue 1, pp 26–33 | Cite as

What Do High-Risk Patients Value? Perspectives on a Care Management Program

  • Ishani Ganguli
  • E. John Orav
  • Eric Weil
  • Timothy G. Ferris
  • Christine Vogeli
Original Research

Abstract

Background

There is growing interest in coordinating care for high-risk patients through care management programs despite inconsistent results on cost reduction. Early evidence suggests patient-centered benefits, but we know little about how participants engage with the programs and what aspects they value.

Objective

To explore care management program participants’ awareness and perceived utility of program offerings.

Design

Cross-sectional telephone survey administered December 2015–January 2016.

Participants

Patients enrolled in a Boston-area primary care-based care management program.

Main measures

Our main outcome was the number of topics in which patients reported having “very helpful” interactions with their care team in the past year. We analyzed awareness of one’s care manager as an intermediate outcome, and then as a primary predictor of the main outcome, along with patient demographics, years in the program, attitudes, and worries as secondary predictors.

Key results

The survey response rate was 45.8% (n = 1220); non-respondents were similar to respondents. More respondents reported worrying about family (72.8%) or financial issues (52.5%) than about their own health (41.6%). Seventy-four percent reported care manager awareness, particularly women (OR 1.33, 95% CI 1.01–1.77) and those with more years in the program (OR 1.16, 95% CI 1.03–1.30). While interaction rates ranged from 19.8% to 72.4% across topics, 81.3% rated at least one interaction as very helpful. Those who were aware of their care manager reported very helpful interactions on more topics (OR 2.77, 95% CI 2.15–3.56), as did women (OR 1.25, 95% CI 1.00–1.55), younger respondents (OR 0.98 for older age, 95% CI 0.97–0.99), and those with higher risk scores (OR 1.04, 95% CI 1.02–1.06), preference for deferring treatment decisions to doctors (OR 2.00, 95% CI 1.60–2.50), and reported control over their health (OR 1.67, 95% CI 1.33–2.10).

Conclusions

High-risk patients reported helpful interactions with their care team around medical and social determinants of health, particularly those who knew their care manager. Promoting care manager awareness may help participants make better use of the program.

KEY WORDS

high-risk care management high cost patients patient-centered care population health management 

Notes

Contributors

We thank Maryann Vienneau (Partners Center for Population Health) and Jessica Moschella, MPH (Emerson Physician-Hospital Organization) for their work on the Partners HealthCare care management program and Tom Bodenheimer, MD, MPH (University of California, San Francisco), for his thoughtful review of our manuscript.

Compliance with ethical standards

Prior presentations

This work was presented at the 2017 Society of General Internal Medicine Annual Meeting on April 21, 2017.

Conflict of interest statement

The authors declare no conflicts of interest.

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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Ishani Ganguli
    • 1
    • 2
  • E. John Orav
    • 1
    • 2
    • 3
  • Eric Weil
    • 2
    • 4
  • Timothy G. Ferris
    • 2
    • 4
  • Christine Vogeli
    • 2
    • 4
  1. 1.Brigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Harvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Massachusetts General HospitalBostonUSA

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