Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115603

Marc Rosenman, MD¹, Ann M. Holmes, PhD², Ronald T. Ackermann, MD, MPH³, Michael D. Murray, PharmD, MPH⁴, Jingjin Li, PhD⁵, Barry P. Katz, PhD⁵, Caroline Carney Doebbeling, MD, MSc¹, Alan J. Zillich, PharmD⁶, Victoria M. Prescott, Esq⁷, Stephen M. Downs, MD, MS⁸, and Thomas S. Inui, ScM, MD¹. (1) Regenstrief Institute, Indiana University School of Medicine, 1001 West 10th Street, Indianapolis, IN 46202, 317-630-7447, mrosenma@iupui.edu, (2) School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 West Michigan Street, Indianapolis, IN 46202, (3) Department of Medicine, Indiana University School of Medicine, 250 University Avenue, Suite 122, Indianapolis, IN 46202, (4) Pharmaceutical Policy and Evaluative Sciences Division, University of North Carolina at Chapel Hill, 7360 Beard Hall, Chapel Hill, NC 27599, (5) Department of Medicine, Division of Biostatistics, Indiana University School of Medicine, 1001 West 10th Street, Indianapolis, IN 46202, (6) Department of Pharmacy Practice, Purdue University, 1001 West 10th Street, W7555 Myers Building, Indianapolis, IN 46202, (7) Regenstrief Institute, 1001 West 10th Street, Indianapolis, IN 46202, (8) Children's Health Services Research, Indiana University School of Medicine, 699 West Drive, Room 330, Indianapolis, IN 46202

Objective: To describe opportunities and challenges in evaluating an innovative statewide initiative to improve health and promote health system change.

Setting: The Indiana Chronic Disease Management Program, implemented by the Indiana Office of Medicaid Policy and Planning and the Indiana State Department of Health

Methods: The State of Indiana is developing and implementing a new program intended to improve quality and cost-effectiveness of care for persons with chronic diseases. It was introduced in July, 2003 for Medicaid members in Central Indiana with diabetes or chronic heart failure and has been expanded statewide during 2004. Chronic heart failure and diabetes among adults were addressed first, followed by asthma among children. The Indiana leadership assembled the program primarily from state and local building blocks. Key ingredients in program development include the assembly of registries of eligible Medicaid members, risk-stratification, a decision-support system, individualized nurse-care management for 10 to 20% of participants, telephonic care management for all participants, and quality improvement activities for primary care practices. The Office of Medicaid Policy and Planning contracts with two statewide organizations to provide nurse care management services; each county is assigned to one organization. Each organization is uniquely qualified, having extensive experience with the Medicaid population and the public health infrastructure across the state. Telephonic care management includes tailored, outbound calls designed to promote self-management. Primary care practice collaborative activities, based on the model for quality improvement in chronic care, are conducted by the Office of Medicaid Policy and Planning and the Indiana State Department of Health, in collaboration with the MacColl Institute.

Results: By early 2005, more than 15,000 Medicaid members with chronic heart failure or diabetes, and more than 9,000 children with asthma, had become eligible for the program. Four sets of primary care practices began participating in chronic care collaborative activities. The program evaluation involves both a randomized trial within Indianapolis and an observational design statewide. It uses information from multiple sources, including Medicaid administrative data, the Regenstrief Medical Records System, assessments made by nurse care managers, and participants' responses during the educational/motivational telephone calls. Challenges in the evaluation include the multifaceted nature of the interventions, the time required before long-term, preventive benefits of self-management would become manifest, and the presence of concurrent changes in practices, delivery systems, and state health policy.

Conclusion: The Indiana experience might offer insights that would be helpful in the evaluation of other statewide disease management programs.

Learning Objectives:

• Understand the challenges of implementing a statewide chronic disease management system for Medicaid members
• Understand state-of-the-art approaches to measuring the impact of such a program and evaluating its performance.

Keywords: Disease Management, Quality Improvement

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF The Indiana Office of Medicaid Policy and Planning has contracted with the Regenstrief Institute (the authors) as consultants in program development and as an evaluation team for the Indiana Chronic Disease Management Program.