Integrated Care for Chronic Conditions: A Randomized Care Management Trial

OBJECTIVES: Health care systems employ communitybased solutions to help individuals manage multiple chronic conditions (MCC). Little knowledge exists on how to optimally translate evidence-based integrated care management models into widespread improvements in patient-centered outcomes. This study aimed to compare effectiveness and differential impact of 3 integrated care management delivery methods. STUDY DESIGN: Individual, stratified randomized trial with a 2:2:1 ratio for high-touch (in person), high-tech (remote monitoring), and optimal discharge planning (ODP; telephonic) delivery methods with 12-month follow-up. METHODS: The UPMC Health Plan provided care management to adult Medicaid and Medicare-Medicaid beneficiaries with MCC who were recently discharged from an inpatient hospitalization. Primary (90-day readmission, health status, patient activation) and secondary (30-day readmission; functional status; quality of life; care satisfaction; emergent care use; engagement in primary, specialty, and mental health care; gaps in care) outcomes were assessed. RESULTS: The analytic sample (n = 1387) included Medicaid (79.5%) or dually eligible (20.5%) beneficiaries with MCC (63.0% female, 73.0% White, and 21.6% Black). We found no evidence of a treatment effect on 90-day readmission rates (P =.669). There was a significant improvement over time for health status (P <.0001) but no significant difference by intervention (P =.866). Patient activation showed a significant time-by-treatment interaction (P =.021), with a significant difference (from baseline to 12 months) for the high-touch approach compared with ODP (adjusted difference of 2.69 points; SE = 1.22; P =.028). Participant subgroups (race, age, illness complexity, and comorbid behavioral health conditions) showed no statistically significant differences by interventions or over time on the primary outcomes. CONCLUSIONS: Results demonstrate how health care systems can leverage a variety of impactful, person-centered care management approaches without compromising patient outcomes.