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Managed care and chronic care: challenges and opportunities
Managed Care Quarterly
|January 2, 1997
Summary
Managed care requires a shift from acute to chronic care models. Optimal systems integrate services and focus on patient quality of life and functional status for better chronic disease management.
Area of Science:
- Health Services Research
- Public Health
- Healthcare Management
Background:
- Managed care is increasingly prevalent, necessitating a focus on chronic condition management.
- Current US medical care predominantly follows an acute care model, which is ill-suited for chronic conditions.
- Chronic conditions require a fundamental reorientation of clinical practice and service organization.
Purpose of the Study:
- To highlight the need for adapting healthcare systems to manage the growing population under managed care.
- To outline the essential characteristics of optimal chronic care systems.
- To identify key areas for Health Maintenance Organizations (HMOs) to target for improving chronic disease care.
Main Methods:
- Analysis of managed care enrollment data.
- Initiation of chronic disease care improvement efforts.
- Redesign of essential support systems within healthcare organizations.
Main Results:
- Optimal chronic care systems integrate primary and specialty care.
- Integration of medical and nonmedical services is crucial for effective chronic care.
- Emphasis on functional status and quality of life are key indicators of successful chronic care.
Conclusions:
- Healthcare systems, particularly HMOs, must adapt to the rise of managed care by prioritizing chronic condition management.
- Reorienting clinical practice and service delivery models is essential for meeting the needs of individuals with chronic illnesses.
- Focusing on integration and patient-centered outcomes like functional status and quality of life will improve chronic care delivery.
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