HQI’s Cindy Warriner and Michelle White contributed to an article recently published in the American Journal of Public Health. The article, “Evaluation of a Chronic Care Management Model for Improving Efficiency and Fiscal Sustainability,” demonstrates the effectiveness of an expanded chronic care management team in an ambulatory setting. Co-authors include Margaret A. Kadree, MD; Patrick Wiggins, MPH; and Lura Thompson, PharmD.
The authors found that chronic care management is effective but faces challenges like reliance on the provider-nurse duo for intensive services and a lack of sustainable funding. Between January and October 2022, an expanded chronic care management team—consisting of a provider, nurse, community health worker, and pharmacist—conducted a four-month intervention. This led to significant improvements in diabetes and blood pressure control for patients, reduced provider workload and an 85.5% Medicare reimbursement rate that supports sustainability of the program design.
