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Managed Care and The Treatment of Chronic Illness

Managed Care and The Treatment of Chronic Illness

August 2001 | 256 pages | SAGE Publications, Inc

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.

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."
Key features

As an individual title, this book will pull its weight. It addresses a central concern in health care for the future. The aging Baby Boomers will shortly place great strains on chronic care facilities in the U.S., and undoubtedly managed care facilities will be obliged to care for a large proportion of them.


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ISBN: 9780761919674