The Better Prepared Comprehensive Case Management (BPCCM) programs offer assistance to participants with nine chronic conditions:  asthma, arthritis, cancer, cardiovascular disease, obstructive lung disease, diabetes, hypertension, high cholesterol, and migraines.  Overall, participants achieved a 46% reduction in severity of conditions, while non-participants had a 12% increase.  BPCCM participants registered a 33% decrease in health care costs, and non-participants a 29% increase over the same period.

Program Strengths Noted Included:
A focus on nine major chronic conditions and use of case management.  There is documentation that case management for higher costs, chronic conditions is effective.  Comprehensive program.  Previous award winner for "Baby Benefits" program in 1995.  Good clinical and cost outcomes.  Long standing commitment to evaluation.  Over 7,000 participants.  Good quality graphics and educational materials.  Excellent test of Nurse Case Management model.

This is an insurance-based case management system that identifies individuals from among a pool of 53,000 covered persons with health care conditions that might benefit from nurse counseling on health behavior changes.  About 2500 individuals participate per year with a total of about 7,000 to date.  The application reports a two-year study of a representative group of participants, targeted non-participants, and other persons covered by this plan; results show reductions in medical expenses and severity of chronic conditions and a positive return on investment as a result of these cost savings.  This a good example of utilizing convenient but reasonably creditable comparison groups for program evaluation.  The case made for program effects and cost savings is relatively strong.

There is a good self-management design.  Return on investment is 1.3 to 1.  There are good outcome indicators.  There is access 24 hours per day, 365 days per year.  The emergency room visits data was particularly strong.  This is a well documented and successful program.

Concerns Observed Included:
There are limits to one program intervention per year.  Progression to the mean is possible and the participation versus non-participation design is not as strong as it might be.  The study design was not discussed in detail.  We do not know for sure if there were linkages to work sites.  Raw data on medical costs needs to be shown, rather that per cent change.  To determine cost benefit, we need to know the cost of the program.  The program must be very expensive if medical costs for participants decreased 33% while costs for non-participants increased 29%, yet the ROI was only 1.30 to 1.  Participation rates were low at 5%, although in another perspective this represents a strength.