Patients' Perspectives of Care Management: A Qualitative Study

Publisher: American Journal of Managed Care, vol. 23, no. 11
Nov 15, 2017
Ann S. O’Malley, Deborah Peikes, Claire Wilson, Rachel Gaddes, Victoria Peebles, Timothy J. Day, and Janel Jin

Objectives. Risk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients’ perspectives of care management are scarce. We explored patients’ experiences with care management, what they found useful, and what needs improvement.

Study Design. Semi-structured qualitative telephone interviews.

Methods. We interviewed 43 high-risk patients or their caregivers who were receiving care management from 11 practices in CMS' Comprehensive Primary Care initiative, provided by nurse care managers (9 practices) or the physician (2 [solo] practices).

Results. Patients’ perceptions of care management were mixed. Patients who had regular contact with, and a desire to work with, their care manager valued the care management services provided. These patients valued care managers who listened to them and explained their conditions and options in lay terms, helped them navigate the healthcare system and community resources, and followed up after hospitalizations. However, one-fifth of the patients in practices that used nurse care managers could not identify their care manager although we: 1) sampled patients who had recent contact with their care manager and 2) defined the care manager’s roles and provided examples of typical care management activities. Patients’ interactions with care managers from health plans and hospitals contributed to confusion.

Conclusions. Practices can improve patient buy-in for care management through in-person introductions to care managers by their physicians, offering care management to patients who need and are interested in it, broader agreement about terminology and the role of care managers and care plans, and better coordination with care management from insurers and hospitals.