The Indiana Chronic Disease Management Program

Milbank Q. 2006;84(1):135-63. doi: 10.1111/j.1468-0009.2006.00441.x.


The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Chronic Disease / nursing*
  • Cooperative Behavior
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Disease Management*
  • Humans
  • Indiana
  • Information Systems
  • Medicaid
  • Physicians, Family
  • Program Development*
  • Quality of Health Care
  • Registries
  • Risk Assessment
  • Telemedicine