Managed Care and The Treatment of Chronic Illness

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Managed Care and The Treatment of Chronic Illness

Jon Brian Christianson - University of Minnesota, USA
David Knutson
Richard Hamer - InterStudy
Ruth A. Taylor - Carlson School of Management
David Abelson - Park Nicollet Information Services
Aylin Altan Riedel - Ingenix Pharmaceutical Services

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October 2001 | 256 pages | SAGE Publications, Inc

This book provides a comprehensive overview and analysis of the current thinking on managed care, exploring the issues related to treating chronic illness in Managed Care Organizations; chronic care in MCOs versus that provided under traditional insurance arrangements; specific programs MCOs have develped and there effectiveness; and futre avenues for development and research.

E. Wagner

Foreword

Preface

1. Introduction

Defining Chronic Illness

Defining Managed Care/Managed Care Organizations

Organizing the Literature Review and Synthesis

Searching for Relevant Literature

Appendiz: Description of Illnessq

2. Chronic Illness and Managed Care: What Are the Issues?

People With Chronic Illness

The Shift to Managed Care

Early Concerns

Current Debate

Research Issues

3. Individuals With Chronic Illness: MCO Versus Fee-for-Service Comparisons

Discussion

4. The Prevalence of Chronic Illness Management Programs in Managed Care Organizations

Background

Small-Scale Studies

The Wagner et al. Study

The InterStudy Survey

Vendor Products and Chronic Illness "Carve-Outs"

Vendor Products for Use With Multiple Diseases

Vendor Products for Specific Chronic Illness

Discussion

5. Use of Administrative and Medical Records Data by MCOs for Chronic Illness Management

Benchmarking

Assessment of Quality of Care

Identification of Opportunities for Improvement

Profiling of Clinics and Providers

Characterization of High-Risk Patients

Simulation of Disease Management Interventions

Summary

6. The Effectiveness of Targeted Initiatives in Treating Chronic Illnesses

Some Definitions

Criteria for Study Selection

Overview of Review Process

Diabetes

Asthma

Congestive Heart Failure

Cardiovascular Disease

Arthritis

Overall Summary and Conclusions

Appendix A

Appendix B

Appendix C

Appendix D

Appendix E

7. Conclusions and Future Research Directions

Observations on Existing Research

Research Challenges for the Future

Index

About the Authors

"Managed Care and the Treatment of Chronic Illness will be a stepping stone for health service researchers, policy analysts and policymakers, managed care administrators, and educators in the fields of medicine, epidemiology, economics, and sociology. The book makes an important addition to the growing literature advocating more comprehensive system change to improve the outcomes of patients with chronic illness."

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