For health plans, one of the biggest challenges in measuring the effectiveness of care management programs is the difficulty in identifying a control group for comparison and measurement. Without a true control group, measuring the impact of a care management program (in terms of preventing avoidable utilization) is difficult.
Care management programs traditionally target high risk individuals – members who are highly likely to have a preventable hospitalization or multiple hospitalizations. These individuals generally have unmanaged chronic conditions and significant socio-economic constraints, such as health literacy, physician access, nutrition issues and more. Because every health plan’s mission and charter are to assist all members that are at risk for adverse outcomes, plans have both a moral and financial obligation to help these members. Consequently, a health plan is not going to withhold critical services from high risk individuals for the purpose of creating a “pure” control group…