Commercial Health Plans' Care Management Activities and The Impact on Costs, Quality and Outcomes: Congressional Testimony

Wednesday, April 11, 2007  | Draper DA

Center for Studying Health System Change
Congressional Testimony before the U.S. Senate Committee on Finance

This congressional testimony is intended to inform the Senate Committee on Finance about information regarding commercial health plans' care management activities and the impact of those activities on costs, quality and outcomes. Information is largely drawn from the Community Tracking Study of Center for Studying Health System Change (HSC), which consists of national surveys of households and physicians in 60 nationally representative communities across the country and intensive site visits to 12 of these communities.

The three key points presented in this testimony are the following:

• Although we have not specifically looked at Medicare Advantage plans in recent years, we have seen a growing trend in commercial health plans offering more care management activities, such as disease management, case management, and health promotion and wellness. Since our research has not specifically focused on Medicare Advantage, we do not know if these activities are also being conducted by Medicare Advantage plans, but the potential is there.
• While many commercial health plans offer care management activities, there is considerable variation across plans as to what is specifically offered and to whom. Health plans often package and brand these types of activities as a way to differentiate themselves in the marketplace. Consequently, determining the extent of these activities or the degree to which they are engaging their enrollees is difficult to assess.
• There is limited evidence to date as to what impact, if any, many of the care management activities that commercial health plans offer have on costs, quality and outcomes. Thus, financial support for these activities is difficult to rationalize unless those providing the funding expect that as health plans gain more experience and sophistication, results will eventually justify the investment.

Full text testimony is available here.