EFFECTIVENESS OF ALTERNATIVE WAYS OF IMPLEMENTING CARE MANAGEMENT COMPONENTS IN MEDICARE D-SNPS: The Care Wisconsin and Gateway Study

Evidence on best practices in care management for chronically ill Medicare beneficiaries offers few clear guidelines about what works best. Given the wide variation both within and across plans in how special needs plan (SNP) services are provided, it becomes important to identify how best to implement or improve intervention components rather than testing only the overall effectiveness of SNPs in general. In this study, we sought to understand which of two alternative ways of implementing each of several components of care management lead to better health outcomes in the two participating SNPs. We used an efficient orthogonal design that allowed us to simultaneously compare effectiveness of alternative approaches to implementing ten components of care management services. Efficient orthogonal designs have been used extensively in manufacturing, and in some health care organizations, but not in published health care evaluations. Such designs enable the testing of multi-component interventions and various ways of deploying each component, offering great potential as a tool for continuous improvement in health care quality. We tested two alternatives--routine care (services routinely provided at the plans before the study) and enhanced care (more frequent or more intensive versions of the services)--for each of ten care components. The tested components included frequency-of-routine contacts; falls-risk screening frequency and referral to fall prevention programs; depression screening frequency, use of depression screening instruments, and mode of referral; member education and coaching strategies; and management of care transitions, including frequency of follow-up and use of protocols and tools.