The Chronic Care Model, developed by Ed Wagner and colleagues at the MacColl Institute, [1] has helped hundreds of providers improve care for people with chronic conditions.  Our understanding of how to improve care has greatly increased and some providers can demonstrate much better results for populations of patients with specific chronic diseases.  Hundreds of organizations have redesigned care using the Chronic Care Model.  Nevertheless, analysis of the US health care system reveals that patients receive recommended and appropriate care in only half of cases. [2]  

There is a pressing need to refine and expand the use of a planned care model so that many more patients, beyond those with chronic illness, can have the kind of health care and symptom reduction that has already been achieved in some settings.  More primary care and other types of practices need new designs for planned care.

But reaching this next level of development, with expanded practice involvement, increased care for multiple conditions, and attention to preventive care, requires surmounting significant barriers:

• Complexity: Planned care requires multiple changes in care processes that are difficult for small practices to learn and make.
• The Business Case: There is not yet a strong business case in the fee-for-service payment system, the predominant model, for a complete implementation of planned care because the savings may be realized in other sectors of the health care system.
• Scalability: Complete implementation of planned care, including prevention and care for patients with multiple chronic conditions, has been difficult to scale up to thousands of patients, although there are some examples to draw on.

There are forces in the health care environment that are fostering spread of planned care, including Centers for Medicare and Medicaid Services (CMS) demonstrations, pilot projects by other payers, and consumer demand.  Still, the path to making planned care efficient, effective and feasible has yet to be developed.  The IHI has an aim to test and implement ideas for building an effective system that delivers the right care, customized for all patients in an efficient and effective way, and is feasible for a practice of thousands of patients.

References:

[1] Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Quarterly. 1996;74(4):511-544.
[2] McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine. 2003;348(26):2635-2645.