Implementing Health Plan-Level Care Management for Solo & Small Practices
Condition: Bipolar Disorder; Depression
MeSH terms: Bipolar Disorder
Study type: Interventional

Summary: 
      This study will determine if a version of the chronic care model for individuals with mood
      disorders seen in small or solo practices can improve patient health.
    

Detailed description: 
      A 2010 HHS report highlighted the prevalence, morbidity, and cost associated with clusters of
      co-occurring chronic conditions, both physical and mental. The report also underscored the
      lack of sustainable treatment strategies for these afflicted individuals, and the
      difficulties in customizing patient-centered interventions.

      Collaborative chronic care models (CCMs) are effective in treating chronic medical and mental
      illnesses at little to no net healthcare cost. To date CCMs have primarily been implemented
      at the facility level and primarily developed for and adopted by larger healthcare
      organizations. However, we have determined that the vast majority of primary care and
      behavioral health practices providing commercially insured care are far too small to
      implement such models. Health plan-level CCMs can address this unmet need.

      Chronic mood disorders (e.g., bipolar disorders, depression) are common and are associated
      with extensive functional impairment, medical comorbidity, and personal and societal costs.
      While unipolar depression is more common, bipolar disorder is more costly on a per patient
      basis due to its chronic and severe nature. Moreover, bipolar disorder is the most expensive
      mental disorder for U.S. commercial health plans and employers. While evidence-based care
      parameters have been well established for mood disorders, quality of care and health outcomes
      in general mental health practice are suboptimal. The majority of these patients suffer from
      clusters of comorbid conditions, both physical and mental. Thus mood disorders represent
      optimal tracer conditions with which to improve management strategies for individuals with
      multiple chronic conditions.

      Accordingly, we have partnered with Aetna Inc. to develop and implement a CCM designed to
      improve outcomes for persons with mood disorders for solo or small practices, with an eye
      towards developing a business case for a generalizable plan-level CCM for chronic disorders.
      We will conduct an RCT of a health plan-level CCM vs. education control. The population of
      interest will be Aetna beneficiaries across the country hospitalized for depression or
      bipolar disorder treated in solo or small primary care or behavioral health practices.
      Patients will be randomized to one year of outpatient treatment augmented by the CCM or
      education control, for a total of 344 participants. Practices participation in the study will
      be limited to completion of an organizational survey. We anticipate 172 practices to complete
      these surveys. CCM care management will be fully remote from practice venues and patients,
      implemented by existing providers (the Aetna care management center). A business case will be
      developed using the Replicating Effective Programs (REP) strategy that identifies
      generalizable facilitators for CCM spread and value added of CCMs to be vetted to key
      industry and policy stakeholders.
    

Intervention name(s): Chronic Care Model for Mood Disorders; Educational Control
Intervention type(s): Behavioral; Other
Intervention description(s): The mood disorders CCM intervention ("Life Goals Collaborative Care") consists of: (a) a web-based patient self-management skills enhancement (CCM-1), (b) enhanced information flow and continuity of care via a care manager (CCM-2), and (c) decision support, or situation-specific evidence-based clinical practice guideline recommendations for providers (CCM-3). The CCM will be implemented utilizing telephonic contact with patients and providers by an Aetna care managers.The care managers will also use the Life Goals web portal as a guide for each session.
Other intervention name(s): Life Goals Collaborative Care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Care Management; Chronic Care Model; Mood Disorders