A Comprehensive Disease Management Program for Medically-Complex Substance Users

Disease management (DM) programs are being increasingly utilized by health plans to
coordinate care, improve quality of care, and control costs in chronically ill individuals.
DM programs for specific medical conditions, such as diabetes mellitus, congestive heart
failure, and asthma, have demonstrated improvements in health outcomes and a number of
studies have found economic benefits to these programs as well. There are fewer data
evaluating multi-disease DM programs, and results have been mixed. Additionally, data on such
programs specifically targeting substance-using populations are limited, although they are
promising. Prior utilization and hospitalization data from Johns Hopkins Hospital, Johns
Hopkins Health Care, and Priority Partners Managed Care Organization (PPMCO) suggest that a
substantial portion of high-utilizing, high-cost, medically complex patients have a substance
use diagnosis.

The investigators hypothesize that a comprehensive DM program for medically-complex substance
users with a history of hospitalization, consisting of intensive nurse case management along
with behavioral incentives to reinforce engagement in primary care, can decrease inpatient
days and costs, as well as improve outcomes for substance use, depression, and physical and
mental functioning. The investigators will compare the case management/behavioral incentives
intervention to usual care among a group of medically-complex, substance-using, PPMCO
enrollees. Usual care will include access to all existing Priority Partners care management
programs, and usual The investigators believe that this research will make an important
contribution to the development of models of chronic care that improve health and promote the
best use of health care resources. Additionally, the investigators believe this project will
promote the study and development of systems to improve the health of substance-using adults,
an underserved and often marginalized group.