Managed Care and The Treatment of Chronic Illness

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 of different editorial boards and scientific advisory panels, and directs the Center for the Study of Healthcare Management in the Department of Healthcare Management at the Carlson School. 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. Before entering the field of research, he spent many years in health care administration. Most recently he held the positions of director of research and development and senior director of provider network management for MedCenters Health Plan, a Twin Cities HMO, and for Aetna Health Plans. His responsibilities included new HMO development, provider contracting, and product management His current research focuses on developing and evaluating risk-based payment methods, on measuring and using information on health plan quality for purchasing, and on the cost-effectiveness of clinical care. Mr. Knutson has published a number of scientific and policy-related articles and co-authored a recently published book on management of chronic illness 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. 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. Christianson on several projects and publications focusing on the management of chronic illness in healthcare organizations. 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." Dr. Abelson earned a medical degree from the University of Minnesota in 1976 and completed an internship and residency in medicine there in 1979. He is a member of several professional organizations, including the American Board of Internal Medicine, the American Medical Association, the American Medical Informatics Association, and the Healthcare Information and Management Systems Society. He is a frequent speaker at national medical forums and symposiums. He has published numerous articles in medical journals and is the author of the book Take Charge of Your Health. 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.

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

"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." -- SirReadaLot.org * SirReadaLot.org *