If you check the National Conference of State Legislatures’ descriptions of the programs as well as the AHRQ ‘how to’ web-site, you’ll note that there is no standard Medicaid template. Once you’ve seen one disease management program, you’ve seen one disease management program. Even with a single disease management company such as McKesson, there is variation. They are fostering assignment of patients to a primary care ‘medical home’ and deploying community based care health workers in Illinois, while in Pennsylvania and Texas, they are deploying a version of pay for performance linked to their programs' recruitment and outcomes.
And speaking of Texas, how about them promotores. Haven't heard of them until you read the DMCB? Well now you know that instead of relying on pricey, remote nurse-based coaching support, it may be appropriate to turn to an alternate care model that depends on lay-health workers who are recruited from the community, are trained and then teach basic self-management skills in the local neighborhood. McKesson, to their credit, picked up on this model also, which was probably an ingredient in securing an extension of their contract. Different States, different Medicaid programs, different approaches.
The DMCB got to meet a real live promotora not too long ago in north Philadelphia and came away seriously impressed. To paraphrase Archimedes, with enough health care workers like her, we can move some serious HbA1c.