A Comprehensive Disease Management Program for Medically-Complex Substance Users

Study Overview
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Brief Summary
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Disease management (DM) programs are being increasingly utilized by health plans to coordinate care, improve quality of care, and control costs in chronically ill individuals. DM programs for specific medical conditions, such as diabetes mellitus, congestive heart failure, and asthma, have demonstrated improvements in health outcomes and a number of studies have found economic benefits to these programs as well. There are fewer data evaluating multi-disease DM programs, and results have been mixed. Additionally, data on such programs specifically targeting substance-using populations are limited, although they are promising. Prior utilization and hospitalization data from Johns Hopkins Hospital, Johns Hopkins Health Care, and Priority Partners Managed Care Organization (PPMCO) suggest that a substantial portion of high-utilizing, high-cost, medically complex patients have a substance use diagnosis. The investigators hypothesize that a comprehensive DM program for medically-complex substance users with a history of hospitalization, consisting of intensive nurse case management along with behavioral incentives to reinforce engagement in primary care, can decrease inpatient days and costs, as well as improve outcomes for substance use, depression, and physical and mental functioning. The investigators will compare the case management/behavioral incentives intervention to usual care among a group of medically-complex, substance-using, PPMCO enrollees. Usual care will include access to all existing Priority Partners care management programs, and usual The investigators believe that this research will make an important contribution to the development of models of chronic care that improve health and promote the best use of health care resources. Additionally, the investigators believe this project will promote the study and development of systems to improve the health of substance-using adults, an underserved and often marginalized group.

Official Title
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A Comprehensive Disease Management Program for Medically-Complex Substance Users

Conditions
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Substance-related Disorder

Intervention / Treatment
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* Behavioral: Contingency Management
* Other: Case management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age over 18 Continuous enrollment in Priority Partners MCO for past 12 months Primary care site East Baltimore Medical Center (EBMC) PPMCO substance abuse flag other than nicotine only within past 24 months Exclusion Criteria: currently enrolled in PPMCO Care Management

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Care Management<br>Care Management plus voucher incentives for adherence to primary care appointments. | Behavioral: Contingency Management<br>* Rite Aid vouchers (stepped value) for reinforcement of adherence to primary care<br>Other: Case management<br>* Nurse case manager assigned to participant<br>|
| No Intervention: Usual care<br>Usual care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Per member per month expenditures |  | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospitalization days |  | 12 months | 
| Outpatient visits |  | 12 months | 
| Emergency Department visits |  | 12 months | 
| Substance use disorder treatment |  | 12 months | 
| Self-reported substance use |  | 12 months | 
| Physical and mental functioning |  | 12 months | 
| Depression |  | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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disease management, substance use disorders, behavioral incentives