The CDM Program Design Framework
- 1Identify: Use claims data and biometric screening to identify members with chronic conditions
- 2Stratify: Segment members by disease severity and risk level
- 3Engage: Reach out to at-risk members and enroll them in appropriate programs
- 4Intervene: Deliver evidence-based interventions (medication adherence, coaching, care coordination)
- 5Monitor: Track clinical outcomes and program engagement
- 6Measure: Report outcomes to leadership and use data to improve programs
Outreach and Engagement
Outreach and engagement are the most challenging aspects of CDM program design. Members who need CDM programs most are often the least likely to enroll voluntarily. Proactive outreach — phone calls, letters, and in-person outreach — significantly improves enrollment rates. Incentives for enrollment and participation also improve engagement.
Measuring Clinical Outcomes
IQ Insight
The most meaningful CDM program metrics are clinical outcomes — HbA1c levels for diabetic members, blood pressure control rates for hypertensive members, and hospitalization rates for all chronic condition members. Participation rates and satisfaction scores are useful but secondary. A program with 90% participation and no improvement in clinical outcomes is not delivering value.