Sustainable care coordination: A qualitative study of primary care provider, administrator, and insurer perspectives

Mark D Williams, Gladys B. Asiedu, Dawn Finnie, Claire Neely, Jason Egginton, Lila J Rutten, Robert M Jacobson

Research output: Contribution to journalArticle

Abstract

Background: Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota. Methods: We used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach. Results: We identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes. Conclusions: Primary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service.

Original languageEnglish (US)
Article number92
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
StatePublished - Feb 1 2019

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Insurance Carriers
Insurance
Administrative Personnel
Primary Health Care
Patient Participation
Centers for Medicare and Medicaid Services (U.S.)
Organized Financing
Consensus
Industry
Cardiovascular Diseases
Organizations
Interviews
Health
Research

Keywords

  • Case management
  • Delivery of health care
  • Health services research
  • Insurance
  • Qualitative research

ASJC Scopus subject areas

  • Health Policy

Cite this

Sustainable care coordination : A qualitative study of primary care provider, administrator, and insurer perspectives. / Williams, Mark D; Asiedu, Gladys B.; Finnie, Dawn; Neely, Claire; Egginton, Jason; Rutten, Lila J; Jacobson, Robert M.

In: BMC Health Services Research, Vol. 19, No. 1, 92, 01.02.2019.

Research output: Contribution to journalArticle

Williams, Mark D ; Asiedu, Gladys B. ; Finnie, Dawn ; Neely, Claire ; Egginton, Jason ; Rutten, Lila J ; Jacobson, Robert M. / Sustainable care coordination : A qualitative study of primary care provider, administrator, and insurer perspectives. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
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