1. Is the quality of case management in a medical home
associated with patient satisfaction and healthcare utilization?
Lindsay Jubelt, MD, Jove Graham, PhD, Daniel Maeng, PhD, Andrew Epstein, PhD, Josh Metlay, MD, PhD
Background Conceptual Model Methods (cont’d) Results (cont’d)
• Data: We linked claims data from the Geisinger • A one point increase in case manager rating
• In 2006, Geisinger Health System initiated a
Health Plan from 2008-20011 to patient resulted in a 0.26 point increase in satisfaction
medical home model, the Proven Health
satisfaction data from the Geisinger Medical rating (p<0.001), and a one point increase in PCP
Navigator (PHN).
Home Patient Satisfaction Survey from 2009- rating resulted in a 0.57 increase in satisfaction
• A central feature of the PHN was to assign
2012. The survey included six questions on rating (p<0.001).
patients with complex medical needs to clinic-
primary care provider (PCP) performance, four
embedded case managers .
questions on case manager performance, and
• In traditional medical care models, stronger Beta Confidence
two questions on satisfaction with care, all on 4-
physician-patient relationships have a positive Coefficient Interval
point Likert scales. For each survey, we
impact on patient satisfaction with care and
generated subscores for PCP performance, case Case Manager Rating 0.26 0.22-0.30
subsequent medical outcomes.
manager performance and overall satisfaction
• Despite the heightened role of case managers PCP Rating 0.57 0.38-0.83
based on the average ratings for questions
in many medical homes, little is known about
within each of these three domains.
the relationship between case manager
• Covariates: Patient characteristics, survey phase,
performance, patient satisfaction with care, Conclusions and Next Steps
case manager subscore, and PCP subscore.
and future health behaviors.
• Outcomes: Overall satisfaction with primary
Objectives care. • Patient perceptions of their case manager and
• Statistical analysis: We used multivariable primary care doctors are both independently
1. Measure the association between patient associated with overall satisfaction with care.
regression to identify significant predictors of
perceptions of case manager performance • The next steps in our analyses will focus on
overall satisfaction, including case manager and
and satisfaction with overall care examining the associations between patient
PCP ratings. The unit of analysis was the
individual patient. perceptions of case management and health care
2. Determine the association between patient utilization patterns.
perceptions of case manager and PCP
performance and subsequent health care Results
utilization Policy Implications
• Case manager ratings (mean=3.7, SD=0.4) , PCP
Methods ratings (mean=3.9, SD=0.3) , and satisfaction • Given the known effect of primary care doctors
ratings (mean=3.8, SD=0.4) did not differ on health care utilization, the independent and
• Study design: Cross-sectional analysis significantly by age, sex, race, MEDai risk score, significant case management finding raises the
of2,147 patients who received primary care or survey phase. possibility that case management may also
in the Geisinger Health System and were • The above covariates were included in the impact patient health outcomes and health
exposed to clinic-embedded case original model but later removed due to lack of behaviors.
management. significance.