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Diabetes in the managed care setting: a prospective plan.
B L Grundel1, G L White, B H Eichold
1Crestview Medical Clinic, Fla, USA.
Southern Medical Journal
|May 26, 1999
Summary
Managed care organizations (MCOs) can improve diabetes care by implementing disease management programs. This approach offers cost-effective, preventive care for chronically ill patients.
Area of Science:
- Healthcare Management
- Chronic Disease Management
- Preventive Medicine
Background:
- Managed care organizations (MCOs) are increasingly involved in chronic illness care.
- Primary care providers (PCPs) must adopt cost-effective, preventive strategies.
- Diabetes management is a key area for implementing such strategies.
Purpose of the Study:
- To outline a framework for MCOs to establish diabetes disease management programs.
- To emphasize the importance of preventive care in managing chronic conditions.
- To guide PCPs in adapting to the managed care environment.
Main Methods:
- Literature review utilizing MEDLINE database.
- Foundation based on American Diabetes Association (ADA) Provider Recognition Program guidelines.
- Development of a diabetes disease management program model for MCOs.
Main Results:
- Disease management protocols are crucial for cost-effective diabetic care.
- Computerized management systems enhance efficiency and effectiveness.
- A team-based approach improves patient outcomes and resource utilization.
Conclusions:
- Collaboration with Independent Practice Associations (IPAs), ADA, and MCOs is vital for providers.
- Standardized protocols and adequate reimbursement are necessary for success.
- Adapting to managed care models is essential for providers to remain competitive.