With the wave of a burgeoning population of elderly patients cresting on the horizon, what do we know now from existing research and literature about managed care systems for patients who are chronically ill? What directions does existing research point toward today; is the available research comprehensive or cursory; and what changes will be required to address successfully this treatment aspect of health care? The purpose of this book is to examine critically and summarize the research on managed care treatment of the chronically ill, to expose what is not yet known in this health care field, and to reveal the outcomes of existing treatment methods. How are those with chronic illness treated in these facilities? How can these patients treatment be improved given available statistics? How can MCOs be altered to address a problem that may become an issue of epidemic proportions in health care tomorrow?
Managed Care and the Treatment of Chronic Illness is a unique presentation of available research in the treatment and outcome of care for the chronically ill patients in managed care settings. Chronic illnesses require frequent and specialized treatment for patients anathema to the short-term and cost-effective objectives of MCOs. Professor Christianson, aided by five expert collaborators, addresses MCO strengths and issues in treating these patients, looks at research results comparing treatment in MCOs versus fee-for-service medicine, and considers the various management techniques and programs to deliver care to enrollees with chronic conditions. Finally the authors critically address the anticipation of the future for this growing population and research: the changes in the MCO environment this population will demand for successful care and the suggested directions for future research. They consider the use of administrative and medical records data by MCOs in benchmarking, assessment, and characterization of high-risk patients. The author concludes with a section on member-wide interventions and the effectiveness of targeted initiatives in treating the specific chronic diseases of asthma, diabetes, cardiovascular disease, arthritis, and congestive heart failure. For anyone interested in the effectiveness of managed care operations, the challenges of treatment of chronic illness, or future health management for the elderly population, this book is a one-of-a-kind examination in its field. 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.
Arvustused
"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." -- SirReadaLot.org * SirReadaLot.org *
Foreword ix Edward Wagner Preface xv Introduction 1(20) Defining Chronic Illness 3(2) Defining Managed Care/Managed Care Organizations 5(3) Organizing the Literature Review and Synthesis 8(2) Searching for Relevant Literature 10(1) Appendix: Description of Illnesses 11(10) Chronic Illness and Managed Care: What Are the issues? 21(18) People With Chronic Illness 22(1) The Shift to Managed Care 23(3) Early Concerns 26(4) Current Debate 30(5) Research Issues 35(4) Individuals With Chronic Illness: MCO Versus Fee-for-Service Comparisons 39(26) Discussion 59(6) The Prevalence of Chronic Illness Management Programs in Managed Care Organizations 65(24) Background 66(2) Small-Scale Studies 68(2) The Wagner et al. Study 70(2) The InterStudy Survey 72(8) Vendor Products and Chronic Illness ``Carve-Outs 80(1) Vendor Products for Use With Multiple Diseases 81(1) Vendor Products for Specific Chronic Illnesses 82(4) Discussion 86(3) Use of Administrative and Medical Records Data by MCOs for Chronic Illness Management 89(24) Benchmarking 91(2) Assessment of Quality of Care 93(2) Identification of Opportunities for Improvement 95(2) Profiling of Clinics and Providers 97(2) Characterization of High-Risk Patients 99(1) Simulation of Disease Management Interventions 100(3) Summary 103(2) Appendix: Studies That Use Administrative Claims and Medical Records Review to Assess the Management of Chronic Illnesses in Managed Care Organizations 105(8) The Effectiveness of Targeted Initiatives in Treating Chronic Illnesses 113(142) Some Definitions 116(2) Criteria for Study Selection 118(1) Overview of Review Process 119(3) Diabetes 122(9) Asthma 131(7) Congestive Heart Failure 138(9) Cardiovascular Disease 147(8) Arthritis 155(11) Overall Summary and Conclusions 166(6) Appendix A: Literature Describing Diabetes Management Programs in Managed Care Organizations 172(23) Appendix B: Literature Describing Asthma Management Programs in Managed Care Organizations 195(17) Appendix C: Literature Describing Congestive Heart Failure Management Programs in Managed Care Organizations 212(13) Appendix D: Literature Describing Cardiovascular Disease Management Programs in Managed Care Organizations 225(15) Appendix E: Literature Describing Arthritis Management Programs in Managed Care Organizations 240(15) Conclusions and Future Research Directions 255(10) Observations in Existing Research 255(5) Research Challenges for the Future 260(5) Index 265(20) About the Authors 285
Jon B. Christianson is an economist with extensive research and teaching experience in the financing and delivery of medical care. He has published in the areas of managed care, rural health care, mental health care, and care process improvement, and has collaborated with health care providers in a variety of practice settings to evaluate new treatment approaches. He received a Ph.D. degree from the University of Wisconsin-Madison and currently is on the faculty of the Carlson School of Management at the University of Minnesota, where he is the James A. Hamilton Chair in Health Policy and Management. Dr. Christianson serves on a number of different editorial boards and scientific advisory panels, and directs the Center for the Study of Healthcare Management in the Department of Healthcare Management at the Carlson School.
Mr. Knutson is Director of Health Systems Studies at the Park Nicollet Institute for Research and Education in Minneapolis. Mr. Knutson directs research on health policy, health economics, and managed care. He also holds adjunct faculty appointments at the University of Minnesota.
Before entering the field of research, he spent many years in health care administration. Most recently he held the positions of director of research and development and senior director of provider network management for MedCenters Health Plan, a Twin Cities HMO, and for Aetna Health Plans. His responsibilities included new HMO development, provider contracting, and product management
His current research focuses on developing and evaluating risk-based payment methods, on measuring and using information on health plan quality for purchasing, and on the cost-effectiveness of clinical care.
Mr. Knutson has published a number of scientific and policy-related articles and co-authored a recently published book on management of chronic illness
Richard L. Hamer is director of InterStudy Publications, a Minneapolis-based health care research and information company. In addition to having responsibility for general management and organizational development, he directs and supervises personnel engaged in InterStudys primary research of select managed care and health care quality management topics. Mr. Hamer has previous experience in corporate health maintenance programs and in financial and management consulting for health and human services organizations. He received a BS from the University of Minnesota and an MA from the University of Toronto.
Ruth Taylor is the coordinator for the Center for the Study of Healthcare Management at the Carlson School of Management, University of Minnesota. She earned a bachelors degree from Valparaiso University. Taylor has extensive experience in program implementation, project management of studies of chronic illness management initiatives in clinical settings, and coordination of both national and local outcomes studies. She is a member of an Institutional Review Board (IRB) for the protection of human subjects in research and sits on the Advisory Committee for a local healthcare systems three IRBs. Ms. Taylor has collaborated with Dr. Christianson on several projects and publications focusing on the management of chronic illness in healthcare organizations.
David J. Abelson, M.D., is chair of the Institute for Clinical Systems Improvement (ICSI) and medical director, information management and care improvements, Park Nicollet Clinic and Methodist Hospital in St. Louis Park, Minnesota. Dr. Abelson was named guideline implementation leader in 1994, and in that role designed and managed support to implement 40 ICSI clinical guidelines. He also designed and managed integration of ambulatory clinical guidelines and hospital pathways as part of a program called "Supporting Best Care."
Dr. Abelson earned a medical degree from the University of Minnesota in 1976 and completed an internship and residency in medicine there in 1979. He is a member of several professional organizations, including the American Board of Internal Medicine, the American Medical Association, the American Medical Informatics Association, and the Healthcare Information and Management Systems Society. He is a frequent speaker at national medical forums and symposiums. He has published numerous articles in medical journals and is the author of the book Take Charge of Your Health.
Aylin Altan Riedel holds a Ph.D. in Health Services Research from the University of Minnesota (2000). At the time of publication she was a researcher in the Health Research Center at the Park Nicollet Institute. She is currently a senior research analyst at Ingenix Pharmaceutical Services. Her research interests focus on health outcomes for individuals with chronic illness, with special focus on how the organization of care delivery, self-management strategies and socioeconomic factors interact to affect outcomes for these patients.
