Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. F. Care Coordination And Disease Management Or Clinical Care Management

12/01/2000

One approach to measuring the coordination of care is on a condition or disease- specific basis. Our TAG agreed that in this project, we should be working toward generic, rather than disease-specific measures of care coordination, especially because the population of people with disabilities in a given MCO is typically so small to slice it up by disease category would make a reliable and valid measurement impossible4 (Corrigan, personal communication).

Nevertheless, it is important to note that, in tandem with the growth of the evidence base about the management of common chronic illnesses. In particular, disease management protocols are becoming more common and more commonly used, especially by MCOs. Such protocols provide guidance about specific events and behaviors which should occur, when they should occur, and often also specify how information should flow. Thus, disease management protocols are like standardized treatment plans, and tracking their implementation would be similar to following up to assure that plans are followed. While useful, standard protocols may also be problematic for the population of people with disabilities, since theyrarely:

  • Address the needs of people with multiple conditions.

  • Take individual variation, even in a single condition, into account.

  • Provide a meaningful role for the patient and/or their family.5

Where appropriate protocols exist, or when they are developed, for certain disabling conditions, it is likely that they will be important resources for MCOs, clinicians and for care coordination. However, at this point in time we are not conceptualizing care coordination as a version of disease management (Woolf 1991; Shaneyfelt 1999).

Perhaps a more critical issue is the relationship of care coordination to clinical care management more generally. The subgroup on care coordination organized by the Center for Health Care Strategies (CHCS), in identifying ten important elements of care coordination, specifically distinguished it from clinical care management (Rosenbach2000). That could seem to imply that something other than clinical care is being managed and further that the person's primary clinician should not be responsible for coordinating their care.

We would argue that the care provided by clinicians is part, though clearly not all, of what should be coordinated. This means that clinical care management is related to care coordination, but that care coordination includes more than clinical management (Desguin 1994; AAP). Further, we would argue that few physicians, whether generalists or specialists, are in a position to coordinate all the care of identified patients with disabilities, given the time constraints under which they operate, as well as their lack of knowledge and training. Staff affiliated with physicians' offices (especially group practices) may be far more appropriate in this role, if and only if, they are willing to conceptualize the job of care coordination as addressing needs that cannot be met by the physicians and other clinicians in the particular practice.

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