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



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.


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


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


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).


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.


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



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.


  1. 1.
    Berry-Millett R, Bodenheimer TS. Care management of patients with complex health care needs. Synth Proj Res Synth Rep.Google Scholar
  2. 2.
    Bodenheimer T, Berry-Millett R. Follow the money—controlling expenditures by improving care for patients needing costly services. N Engl J Med. 2009;361:1521-3.CrossRefPubMedGoogle Scholar
  3. 3.
    Colbert J, Ganguli I. To Identify Patients For Care Management Interventions, Look Beyond Big Data. Health Affairs Blog. April 19, 2016. Accessed April 4, 2017.
  4. 4.
    Nelson L. Lessons From Medicare’s Demonstration Projects on Disease Management and Care Coordination. Washington, DC: Congressional Budget Office; 2012. Working paper 2012–01.Google Scholar
  5. 5.
    Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009;301:603-18.CrossRefPubMedGoogle Scholar
  6. 6.
    Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood). 2012;31:1156-66.CrossRefGoogle Scholar
  7. 7.
    Zulman DM, Cee CP, Ezeji-Okoye SC, et al. Effect of an intensive outpatient program to augment primary care for high-need Veterans Affairs patients: a randomized clinical trial. JAMA Intern Med. 2017;177:166-175.CrossRefPubMedGoogle Scholar
  8. 8.
    McCall N, Cromwell J, Urato C. Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Massachusetts General Hospital and Massachusetts General Physicians Organization (MGH). 2010. Accessed November 14, 2016.
  9. 9.
    McWilliams JM, Landon BE, Chernew ME, Zaslavsky AM. Changes in patients’ experiences in Medicare accountable care organizations. N Engl J Med. 2014; 371:1715-1724.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    McWilliams JM. Cost containment and the tale of care coordination. N Engl J Med. 2016; 375:2218-2220.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fryer AK, Friedberg MW, Thompson RW, Singer SJ. Achieving care integration from the patients’ perspective: results from a care management program. Healthc (Amst). 2016;4:36-44.CrossRefPubMedGoogle Scholar
  12. 12.
    Ganguli I, Thompson RT, Ferris TG. What can five high cost patients teach us about healthcare spending? Healthc (Amst). 2016.
  13. 13.
    Urato C, McCall N, Cromwell J, Lenfestey N, Smith K, and Raeder, D. Evaluation of the Extended Medicare Care Management for High Cost Beneficiaries (CMHCB) demonstration: Massachusetts General Hospital (MGH). Final report. Research Triangle Park, NC: RTI International. 2013.Google Scholar
  14. 14.
    Hong CS, Siegel AL, Ferris TG. Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? The Commonwealth Fund, August 2014.Google Scholar
  15. 15.
    Hsu J, Price M, Vogeli C, Chernew M, Ferris TG. The impact of new payment models on care delivery: reductions in emergency care use among beneficiaries in a Medicare Pioneer ACO. Int J Qual Health Care. 2016;28(suppl 1).Google Scholar
  16. 16.
    Vogeli C, Spirt J, Brand R, Hsu J, Mohta N, Hong C, Weil E, Ferris TG. Implementing a hybrid approach to select patients for care management: variations across practices. Am J Manag Care. 2016;22:358-65.PubMedGoogle Scholar
  17. 17.
    Gelberg L, Gallagher TC, Andersen RM, Koegel P. Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health. 1997;87:217-220.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    American Community Survey. Accessed April 4, 2017.
  19. 19.
    The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. April 2015. Accessed January 23, 2017.
  20. 20.
    Berkowitz SA, Hulberg AC, Hong C, Stowell BJ, Tirozzi KJ, Traore CY, Atlas SJ. Addressing basic resource needs to improve primary care quality: a community collaboration programme. BMJ Qual Saf. 2016;25:164-72.CrossRefPubMedGoogle Scholar
  21. 21.
    Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48:1-8.CrossRefPubMedGoogle Scholar
  22. 22.
    Sutherland JM, Fisher ES, Skinner JS. Getting past denial—the high cost of health care in the United States. N Engl J Med. 2009;361:1227-1330.CrossRefPubMedGoogle Scholar
  23. 23.
    Health Policy Commission. 2013 Cost Trends Report. Boston, MA. 2013 Accessed April 4, 2017.
  24. 24.
    Johnson TL, Rinehart DJ, Durfee J et al. For many patients who use large amounts of health care services, the need is intense yet temporary. Health Aff (Millwood). 2015;34:1312-9.CrossRefPubMedGoogle Scholar
  25. 25.
    Ryan J, Abrams MK, Doty MM, Shah T, Schneider EC. How High-Need Patients Experience Health Care in the United States: Findings from the 2016 Commonwealth Fund Survey of High-Need Patients, The Commonwealth Fund, December 2016.Google Scholar
  26. 26.
    Schlossstein E, St. Clair P, Connell F. Referral keeping in homeless women. J Community Health. 1991;16:279-285.CrossRefPubMedGoogle Scholar
  27. 27.
    Zulman DM, Kerr EA, Hofer TP, Heisler M, Zikmund-Fisher BJ. Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients. J Gen Intern Med. 2010;208-414.Google Scholar
  28. 28.
    Mautner DB, Pang H, Brenner JC, Shea JA, Gross KS, Frasso R, Cannuscio CC. Generating hypotheses about care needs of high utilizers: lessons from patient interviews. Popul Health Manag. 2013;16 Suppl 1:S26-33.PubMedGoogle Scholar
  29. 29.
    Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State worry questionnaire. Behav Res Ther. 1990;28:487-95.CrossRefPubMedGoogle Scholar
  30. 30.
    Berkowitz SA, Hulberg AC, Standish S et al. Addressing unmet basic resource needs as part of chronic cardiometabolic disease management. JAMA Intern Med. 2017;177:244-252.CrossRefPubMedGoogle Scholar
  31. 31.
    Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49:147-52.PubMedGoogle Scholar
  32. 32.
    Bertakis KD. The influence of gender on the doctor-patient interaction. Patient Educ Couns. 2009;76:356-60.CrossRefPubMedGoogle Scholar
  33. 33.
    Tak HJ, Ruhnke GW, Meltzer DO. Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients. JAMA Intern Med. 2013; 173:1195-1205.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ganguli I, Sikora C, Nestor B, et al. A scalable program for customized patient education videos. Jt Comm J Qual Patient Saf. 2017.
  35. 35.
    Elliott MN, Zaslavsky AM, Goldstein E, et al. Effects of survey mode, patient mix, and nonresponse on CAHPS hospital survey scores. Health Serv Res. 2009;44:501-518.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Davern M. Nonresponse rates are a problematic indicator of nonresponse bias in survey research. Health Serv Res 2013;48:905-12.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Hong CS, Hwang AS, Ferris TG. Finding a Match: How Successful Complex Care Programs Identify Patients. Issue Brief California HealthCare Foundation. Accessed July 14, 2017.

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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