Managed care and chronic care: challenges and opportunities

As managed care enrolls an increasing proportion of the population, increased attention needs to be paid to the care of persons with chronic conditions. This trend is occurring in the context of medical care in the United States that is deeply rooted in the acute care model of illness. The distinctive character of chronic conditions requires a reorientation of clinical practice and the way in which medical and nonmedical services are organized. Optimal chronic care systems are characterized by the integration of primary and specialty care, integration of medical and nonmedical services, and emphasis on functional status and quality of life. Analyzing enrollment data, beginning chronic disease care improvement efforts, and redesigning key support systems are all targets for HMO action.