Back to the drawing board: New directions in health plans' care management strategies

Health Affairs

Volumn 21, Issue 5, 2002, Pages 210-217

  Felt Lisk, Suzanne ^a   Mays, Glen P ^a  

^a MATHEMATICA POLICY RESEARCH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHRONIC DISEASE; DISEASE MANAGEMENT; ECONOMIC ASPECT; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH SERVICES RESEARCH; HUMAN; INTERVIEW; LONGITUDINAL STUDY; ORGANIZATION AND MANAGEMENT; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

CHRONIC DISEASE; CONCURRENT REVIEW; DISEASE MANAGEMENT; ECONOMIC COMPETITION; HEALTH POLICY; HEALTH SERVICES RESEARCH; HUMANS; INTERVIEWS; LONGITUDINAL STUDIES; MANAGED CARE PROGRAMS; UNITED STATES; UTILIZATION REVIEW;

EID: 0036717221     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.21.5.210     Document Type: Article

References (16)

1. Care management strategies are administrative processes and clinical programs used to influence the volume, intensity, and quality of health care received by consumers.
2. H.T. Tu, P. Kemper, and H.L Wong, "Do HMOs Make a Difference? Use of Health Services," Inquiry 36, no. 4 (1999): 400-410; and R.S. Thompson, "What Have HMOs Learned about Clinical Prevention Services? An Examination of the Experience at Group Heahh Cooperative of Puget Sound," Milbank: Quarterly 74, no. 4 (1996): 469-509.
3. H.T. Tu, P. Kemper, and H.L Wong, "Do HMOs Make a Difference? Use of Health Services," Inquiry 36, no. 4 (1999): 400-410; and R.S. Thompson, "What Have HMOs Learned about Clinical Prevention Services? An Examination of the Experience at Group Heahh Cooperative of Puget Sound," Milbank: Quarterly 74, no. 4 (1996): 469-509.
4. For a review of this evidence on utilization management, see S. Glied, "Managed Care," in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (Amsterdam: North-Holland, 2000); and T.M. Wickizer and D. Lessler, "Utilization Management: Issues, Effects, and Future Prospects," Annual Review of Public Health 23 (2002): 233-254. For evidence and limitations of evidence on disease management programs, see G. Ellrodt et al., "Evidence-Based Disease Management," Journal of the American Medical Association 278, no. 20 (1997): 1687-1692. Other studies on individual conditions include L.F. Rossiter et al., "The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients," Inquiry 37, no. 3 (2000): 188-202; J. Sidorov et al., "Does Diabetes Disease Management Save Money and Improve Out-comes?" Diabetes Care 25, no. 4 (2002): 684-689; and M.W. Rich, "Heart Failure Disease Management, A Critical Review," Journal of Cardiac Failure 5, no. 1(1999): 64-75.
5. For a review of this evidence on utilization management, see S. Glied, "Managed Care," in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (Amsterdam: North-Holland, 2000); and T.M. Wickizer and D. Lessler, "Utilization Management: Issues, Effects, and Future Prospects," Annual Review of Public Health 23 (2002): 233-254. For evidence and limitations of evidence on disease management programs, see G. Ellrodt et al., "Evidence-Based Disease Management," Journal of the American Medical Association 278, no. 20 (1997): 1687-1692. Other studies on individual conditions include L.F. Rossiter et al., "The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients," Inquiry 37, no. 3 (2000): 188-202; J. Sidorov et al., "Does Diabetes Disease Management Save Money and Improve Out-comes?" Diabetes Care 25, no. 4 (2002): 684-689; and M.W. Rich, "Heart Failure Disease Management, A Critical Review," Journal of Cardiac Failure 5, no. 1(1999): 64-75.
6. For a review of this evidence on utilization management, see S. Glied, "Managed Care," in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (Amsterdam: North-Holland, 2000); and T.M. Wickizer and D. Lessler, "Utilization Management: Issues, Effects, and Future Prospects," Annual Review of Public Health 23 (2002): 233-254. For evidence and limitations of evidence on disease management programs, see G. Ellrodt et al., "Evidence-Based Disease Management," Journal of the American Medical Association 278, no. 20 (1997): 1687-1692. Other studies on individual conditions include L.F. Rossiter et al., "The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients," Inquiry 37, no. 3 (2000): 188-202; J. Sidorov et al., "Does Diabetes Disease Management Save Money and Improve Out-comes?" Diabetes Care 25, no. 4 (2002): 684-689; and M.W. Rich, "Heart Failure Disease Management, A Critical Review," Journal of Cardiac Failure 5, no. 1(1999): 64-75.
7. For a review of this evidence on utilization management, see S. Glied, "Managed Care," in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (Amsterdam: North-Holland, 2000); and T.M. Wickizer and D. Lessler, "Utilization Management: Issues, Effects, and Future Prospects," Annual Review of Public Health 23 (2002): 233-254. For evidence and limitations of evidence on disease management programs, see G. Ellrodt et al., "Evidence-Based Disease Management," Journal of the American Medical Association 278, no. 20 (1997): 1687-1692. Other studies on individual conditions include L.F. Rossiter et al., "The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients," Inquiry 37, no. 3 (2000): 188-202; J. Sidorov et al., "Does Diabetes Disease Management Save Money and Improve Out-comes?" Diabetes Care 25, no. 4 (2002): 684-689; and M.W. Rich, "Heart Failure Disease Management, A Critical Review," Journal of Cardiac Failure 5, no. 1(1999): 64-75.
8. For a review of this evidence on utilization management, see S. Glied, "Managed Care," in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (Amsterdam: North-Holland, 2000); and T.M. Wickizer and D. Lessler, "Utilization Management: Issues, Effects, and Future Prospects," Annual Review of Public Health 23 (2002): 233-254. For evidence and limitations of evidence on disease management programs, see G. Ellrodt et al., "Evidence-Based Disease Management," Journal of the American Medical Association 278, no. 20 (1997): 1687-1692. Other studies on individual conditions include L.F. Rossiter et al., "The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients," Inquiry 37, no. 3 (2000): 188-202; J. Sidorov et al., "Does Diabetes Disease Management Save Money and Improve Out-comes?" Diabetes Care 25, no. 4 (2002): 684-689; and M.W. Rich, "Heart Failure Disease Management, A Critical Review," Journal of Cardiac Failure 5, no. 1(1999): 64-75.
9. For a review of this evidence on utilization management, see S. Glied, "Managed Care," in Handbook of Health Economics, ed. A.J. Culyer and J.P. Newhouse (Amsterdam: North-Holland, 2000); and T.M. Wickizer and D. Lessler, "Utilization Management: Issues, Effects, and Future Prospects," Annual Review of Public Health 23 (2002): 233-254. For evidence and limitations of evidence on disease management programs, see G. Ellrodt et al., "Evidence-Based Disease Management," Journal of the American Medical Association 278, no. 20 (1997): 1687-1692. Other studies on individual conditions include L.F. Rossiter et al., "The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients," Inquiry 37, no. 3 (2000): 188-202; J. Sidorov et al., "Does Diabetes Disease Management Save Money and Improve Out-comes?" Diabetes Care 25, no. 4 (2002): 684-689; and M.W. Rich, "Heart Failure Disease Management, A Critical Review," Journal of Cardiac Failure 5, no. 1(1999): 64-75.
10. L.T. Kohn. "Organizing and Managing Care in a Changing Health System," Health Services Research 35, no. 1(2000): 37-52.
11. Other reasons for small size included technical issues in identifying and gaining participation by those eligible, and concerns about whether a large program was feasible.
12. Hargraves and Trude, "Obstacles to Employers' Pursuit of Health Care Quality."
13. E.M. Rogers, Diffusion of Innovations, 4th ed. (New York: Free Press, 1995); and D.R. Wholey et al., "The Diffusion of Information Technology among Health Maintenance Organizations," Health Care Management Review 25, no. 2 (2000): 24-33.
14. E.M. Rogers, Diffusion of Innovations, 4th ed. (New York: Free Press, 1995); and D.R. Wholey et al., "The Diffusion of Information Technology among Health Maintenance Organizations," Health Care Management Review 25, no. 2 (2000): 24-33.
15. The United Healthcare Care Coordination model includes disease management programs for cardiovascular disease, asthma, and diabetes (including educational materials for participants and case management for high-risk individuals); preadmission counseling; and postdischarge calls to ensure patients' access to medications, self-care information, and supplies. The CIGNA Well Aware Program for Better Health includes extensive educational and self-care tools for people with diabetes, heart disease, asthma, and low-back pain.
16. This statement is based on reports from the health plans about what influenced their program development and thus differs somewhat from the findings reported in Hargraves and Trude, "Obstacles to Employers' Pursuit of Health Care Quality."