Managed Care and The Treatment of Chronic Illness

Foreword - E. Wagner
Preface
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
Discussion
4. The Prevalence of Chronic Illness Management Programs in Managed Care Organizations
Background
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
Discussion
5. Use of Administrative and Medical Records Data by MCOs for Chronic Illness Management
Benchmarking
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
Summary
6. The Effectiveness of Targeted Initiatives in Treating Chronic Illnesses
Some Definitions
Criteria for Study Selection
Overview of Review Process
Diabetes
Asthma
Congestive Heart Failure
Cardiovascular Disease
Arthritis
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
Index
About the Authors