Here's a good review of all the reasons why care management has not become a routine part of patient care.
As policymakers, reformists, consultants and architects plan for a population and outcomes-based future, they'd be wise to think about the review's 17-point reality check.
1) Start-up costs are considerable;
2) Costly to maintain;
3) Multi-year time horizon for any return on investment;
4) Any success undercuts future traditional fee-for-service revenue;
5) Can't be broken down into discreet 'reimbursible" units for fee-for-service payments;
6) It's paid for with still-novel-experimental capitated payments and/or shared savings;
7) The link between increased quality today and downstream savings tomorrow is still tenuous;
8) Complicates primary care by introducing more uncertainty;
9) Non-physician manager training is time-consuming and costly;
10) It's a resource that is best reserved for high risk patients, not all patients;
11) Doesn't fit into long-standing clinical workflows in established clinics;
12) Primary care already has enough challenges and implementing care management is not a priority;
13) Most EHRs are not configured to document or support non-physician care;
14) Decision-makers need additional information on expected net savings;
15) It relies on a lot of outside-the-doc-comfort zone behavioral, vs. "medical" health interventions;
16) It requires considerable data support;
17) It's often balkanized by multiple payers.
But be of good cheer. Jimmy Cliff reminds us that half the battle is knowing what you're up against.