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Care managers improve practice management, patient outcomes

John L. Bender

Primary care practices with a designated care manager had patients with improved diabetic- and obesity-related outcomes when compared with practices within the same organization, according to recent findings in the Journal of Primary Care and Community Health.

“Since the overwhelming majority of patients receive care for their chronic conditions from primary care practices, this is an important venue to assist patients in taking these steps,” Jodi Summers Holtrop, PhD, department of family medicine at the University of Colorado Denver School of Medicine, and colleagues wrote, adding that nearly half of all adults have at least one chronic illness.

Researchers wrote that care managers’ responsibilities are usually performed by pharmacists, dieticians, social workers or nurses, and can include self-management support, chronic disease management and care coordination. These tasks are usually carried out with the patient through a phone call or face-to-face communication.

For this study, care managers were trained to identify a practice plan for care implementation via ongoing planning sessions with their assigned practice; developing a community resource and referral guide; performing patient assessments; care management improvements; electronic medical record use; managing behavioral health issues; behavioral change strategies using motivational interviewing; and didactic instruction on target conditions.

Holtrop and colleagues analyzed data from 56,048 adult patients who had at least one visit in the past 2 years, and had been previously diagnosed with either type 2 diabetes or obesity (BMI, 30 kg/m²).

At 1 year, there was a 12% relative increase in the proportion of patients meeting the clinical target A1c level of less than 7% (95% CI, 3-20).

In addition, 26% of obese nondiabetic patients in chronic care management practices lost 5% or more of their body weight compared with 10% of patients who did not see a care manager (adjusted relative improvement, 15%; 95% CI, 2-28).

“Continuing research should explore the factors necessary for all practices to implement care management to achieve these improved results,” the researchers wrote.

A practicing family physician in Fort Collins Colorado who has used a care manager model in his own practice affirmed Holtrop and colleagues’ findings.

“On the whole, we have more patients who have achieved their goals, such as lowering [hemoglobin] A1C, LDL and hypertension levels than patients seen by some of our peers,” John L. Bender, MD, MBA, senior partner and CEO at Miramont Family Medicine, told Healio Family Medicine in an interview.

He added that care managers should not simply be seen as just another person on the practice’s payroll, but rather as a valuable team player in a patient’s wellness.

“Care managers can help get patients into the exam room and talk to them about changing their diet and other important things, but if they need a new medication or insulin dose, the physician will need to be involved as well,” Bender said. “We’ve found that when the patient, care manager and physician are engaged, that is when we see better outcomes.” – by Janel Miller

Disclosures: The study researchers report no relevant financial disclosures. Bender reports employment with his own medical practice.