NYMC Student Theses and Dissertations

Date of Award

4-29-2019

Document Type

Doctoral Dissertation

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Adam Block, PhD

Second Advisor

Keosha Bond, EdD, MPH, CHES

Third Advisor

Deborah Viola, MBA, PhD

Abstract

Background: As the nation shifts to value based payment programs (VBP), financial incentives drive primary care providers (PCPs) to improve outcomes and reduce costs. One method to drive physicians to focus their practices and to increase time working at the top of their licenses is the use of care management (CM) services to meet these goals but the resources needed to implement CM are a barrier. In the Hudson Valley, PCPs embedded local CM staff to provide CM services. This study assesses the provider and care manager perceived patient outcomes from CM, barriers to successful implementation, resources required, total cost of this integration and the sustainability of subcontracting for CM. Methods: In 2017, care managers were embedded in six PCP practices. Using an exploratory sequential study, Care Managers and PCPs received open ended surveys. Themes were coded. Resources were identified to calculate the total cost with additional cost data. The threshold of patients to cover the total cost was calculated and a sensitivity analysis was performed. Results: The perceived impact of CM on the health of patients was mixed. Barriers to the implementation included: staff not understanding the role of the care manager, lack of relationship between the care manager and PCP, lack of patient trust and PCP time constraints. Resources identified included items such as computers. The cost for the first year of CM was $64,307. Practices require 1072 patients with a $5PMPM CM reimbursement. Conclusion: Results of this study are aligned with the literature. This study suggests CM impact on outcomes is mixed. Training practice staff would mitigate barriers care managers face. Subcontracted CM is a potentially sustainable model with enough patients in a VBP arrangement. Subcontracting for part time CM may be a model for smaller practices.

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