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Managed Care and The Treatment of Chronic Illness

Managed Care and The Treatment of Chronic Illness

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August 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
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

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

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


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

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


6. The Effectiveness of Targeted Initiatives in Treating Chronic Illnesses
Some Definitions

Criteria for Study Selection

Overview of Review Process



Congestive Heart Failure

Cardiovascular Disease


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

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."

Jon B. Christianson

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... More About Author

David J. Knutson

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. ... More About Author

Richard L. Hamer

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 InterStudy’s 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.   More About Author

Ruth A. Taylor

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 bachelor’s 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 system’s three IRBs. Ms. Taylor has collaborated with Dr.... More About Author

David J. Abelson

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." ... More About Author

Aylin Altan Riedel

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.  More About Author

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ISBN: 9780761919674