Quality and Features of Managed Care for Chronic Conditions
Under the leadership and oversight of the Center of Organization and Delivery Studies (CODS), AHRQ co-funds research to determine the impact of different features of health plans on the quality of care provided to patients with chronic illnesses.
Studies of outcomes and managed care features by 7 teams will be based on new data and patient records from 32 health plans, including industry giants such has United Healthcare, Kaiser Permanente and Harvard Pilgrim Health Plan. Also participating are government-sponsored programs in 5 States and 50 medical group practices affiliated with Pacific Business Group on Health.
The studies are jointly supported by:
- Agency for Healthcare Research and Quality (AHRQ).
- American Association of Health Plans Foundation.
- Health Resources and Services Administration.
- Robert Wood Johnson Foundation.
The seven teams are led by:
- Jose Escarce, M.D., Ph.D., RAND. This study covers working-age members of seven United
Healthcare plans in different parts of the country treated for diabetic retinopathy and open-angle
glaucoma, both leading causes of blindness.
- Edward Guadagnoli, Ph.D., Harvard Medical School. This study includes diabetic and
hypertensive patients enrolled in the plans of Allina, Preferred One, and U-Care in the
Minneapolis-St.Paul area.
- Katherine Kahn, M.D., UCLA. This study addresses patients with chronic heart and lung
diseases served by 50+ group practices that are utilized by companies who belong to the Pacific
Business Group on Health.
- Tracy Lieu, M.D., Harvard Pilgrim Health Plan (formerly at Kaiser Permanente of Northern
California). The study is focused on children with asthma and enrolled in Medicaid managed care plans
in California, Massachusetts and Washington.
- Barbara McNeil, M.D., Harvard Medical School. This is a study of care for Members of
Allina, United Health Care, Tufts health plan and Pacificare treated for heart attack, congestive heart
failure or hypertension.
- Elizabeth Shenkman, Ph.D., University of Florida. This study includes low-income children
in Florida's Healthy Kids Program who suffer from asthma, diabetes or other chronic problems.
Participating groups include the Health Insurance Plan of Florida, Health Option/Blue Cross-Blue Shield
of Florida, Humana, Florida Health Care Plans, Florida First, Physicians= Corporation of
America-Family, Jackson Memorial Trust Plan of Florida, Av-Med Health Plan and Physicians' Health
Plan.
- Bruce Stuart, Ph.D., Univ. of Maryland. This is a study of children with asthma enrolled in
Medicaid before and after the change to a statewide managed care system with nine contracting
plans.
After 2 years, each of these studies has made progress in the following areas:
- Selecting patients: several hundred patients each, with the relevant chronic conditions;
identifying providers and their practice settings.
- Assessing quality of care: projects have contacted physician offices and undertaken chart reviews.
Most projects are also assembling claims from health plans. Adherence to guidelines of care will be
assessed.
- Telephone surveys and in-person interviews are being conducted to ask about patient
functioning/satisfaction.
- Interviews or surveys are being held with health plan executives and medical group managers about
the features of managed care, including: benefit coverage and coinsurance for patients, financial
arrangements affecting providers, and managerial operations affecting individual
providers.
Current as of May 2001
Internet Citation:
Quality and Features of Managed Care for Chronic Conditions. May 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cods/mgdchron.htm
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