A Continuing Care Management Model of Health Care in Miami Reduces Emergency Department Use

Managed care project for chronically ill people in Dade County

From 1993 to 1995, staff at the University of Miami School of Medicine assessed and further developed their existing continuing care management model of care for low-income chronically ill people in Dade County Fla.

The continuing care management model relied on:

  • Generalist practitioners who acted as "tour guides" through the medical system (rather than in their traditional "gatekeeper" role) to ensure that patients received care that was comprehensive, continuous and coordinated.
  • A "continuing care plan" generated for discharged patients and forwarded to the ambulatory care site where the patient received general medical care.

Key Findings: Interviews with medical personnel and a retrospective review of medical records established that:

  • When continuing care plans were available, providers used the information to improve patient care.
  • In the absence of such information, care was compromised.

Key Results:

  • The project team used these findings to initiate interventions at a local hospital (Jackson Memorial) and affiliated institutions to improve continuity of care, including:
    • Creating an online version of the continuing care plan.
    • Educational materials and training for continuing care management providers, referring physicians, University of Miami residents, and patients.
    • Although the practice of the Continuing Care Model within Jackson Memorial Hospital and the existing network improved, external developments in the Dade County health care environment curbed the anticipated expansion of the model.
  • The advent of Medicare and Medicaid managed care in the mid-1990s shifted interest from the informal networking and incremental approach to ensuring continuity of care to a more formal, contractual model with fierce competition for funded patients.
  • After the grant closed in 1995, a partnership was formed between JMH and a for-profit provider, further eroding support for a CCM network.
  • Although support for an informal vertical network of providers waned, interest in the generalist physician model of care promoted by CCM was greatly heightened with the advent of managed care.