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Managed Care and The Treatment of Chronic Illness

Managed Care and The Treatment of Chronic Illness

Other Titles in:
Substance Abuse Counselling

October 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."

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ISBN: 9780761919674