Primary care practices across the United States are implementing a new model of care, the patient-centered medical home (PCMH), in an effort to improve care to patients and, consequently, control health care costs. The addition of care managers is a key aspect of PCMH implementation with important implications for the production and reproduction of authoritative knowledge in primary care. Redistribution of patient interaction from the primary care provider to a range of other health care providers in this model of care is a significant means by which primary care approaches to the prevention and management of chronic diseases such as diabetes are being transformed. Based on a study of a health insurance company-sponsored primary care transformation project in Michigan, we explore the perceptions of care management from the perspective of providers and practice staff to examine these shifts in knowledge and their broader implications for primary care. This research demonstrates how the diffusion of clinical power and knowledge production redefine primary care relationships to patients, as traditional hierarchies shift to team-based care. The addition of care managers reshapes power and agency within clinical practice and understandings of the social dimensions of chronic illness. Care management emphasizes the affective qualities of provider care-giving, euphemized in terms of teamwork, partnerships, and relationships; however, these are also measured through the perceptions of patient transformation into self-managed owners of their illness.

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