For 10 years (1994–2004), the HMO Workgroup on Care Management published recommendations on, and highlighted opportunities and challenges in, care management practices for chronically ill older patients under capitated arrangements—those in which the provider is paid a fixed amount for a patient over a given period no matter what the actual number or nature of services delivered.
The workgroup was composed of representatives from selected health plans and capitated group practices and researchers.
The Robert Wood Johnson Foundation (RWJF) supported this project—first as part of the national program Chronic Care Initiatives in HMOs, and then, after the program ended, through grants to the Washington-based AAHP Foundation (now called America's Health Insurance Plans [AHIP]). The project director estimates that the workgroup cost a little over $1 million paid from these grants.
The HMO Workgroup on Care Management generated documentable improvements in care for chronically ill seniors in major health plans and capitated medical groups (e.g., Kaiser Permanente, Lahey Clinic, Group Health Cooperative of Puget Sound, Oxford Health Plans).
Managed care organizations should: