Diabetes Care Management Initiatives in Managed Care Organizations
Open Access
- Author:
- Beich, Jeff
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 03, 2005
- Committee Members:
- Dennis Patrick Scanlon, Committee Chair/Co-Chair
Eric Ford, Committee Member
Jan Ulbrecht, Committee Member
Marianne Messersmith Hillemeier, Committee Member
Ibrahim Adnan Ibrahim, Committee Member - Keywords:
- disease management
quality improvement
diabetes
managed care
chronic conditions
cluster analysis - Abstract:
- Abstract Objective: To describe, evaluate and assess applications of Quality Improvement (QI) and Disease Management (DM) strategies by Managed-Care Organizations (MCOs) towards their members with diabetes. Study Design: Analysis of a sample of Quality Improvement Activities (QIAs) conducted by MCOs targeted at members with diabetes between 1994 and 1999. Cross-sectional analysis of 2002 eValue8 Request For Information (RFI) diabetes module data. Data Sources: Data were obtained from 63-blinded QIA reports provided by the National Committee on Quality Assurance (NCQA) and from the National Business Coalition on Health’s (NBCH) RFI diabetes module results for 50 MCOs. Supplementary data were obtained from InterStudy’s MSA Profiler and Competitive Edge (calendar years 1996-2001) and NCQA’s HEDIS data (calendar years 2001 and 2002). Methods: Data were abstracted from the QIAs using content analysis. Models for an MCO-sponsored DM program and a QI process were developed and used as conceptual frameworks for analyses. An evaluation tool was developed to assess QIA performance. Model components were analyzed using frequencies, measures of central tendencies, measures of variation, agglomerated hierarchical cluster analysis and statistics of association. Relationships between RFI diabetes module scores and HEDIS diabetes results were tested using ordinary least squares and logistic regression. Principal Findings: Both DM and QI programs revealed substantial variation in the implementation of key model components. QIA results indicate that plans generally, perform poorly in analyzing the root causes of quality problems. Cluster analysis of member interventions in RFIs found that many plans relied primarily on printed materials for education of members. Scores assessing overall implementation of both programs indicated that while some plans performed well, on average, most were in need of improvement. Regression analysis found minimal relationships between RFI scores and HEDIS results, suggesting that the scores had limited ability to discriminate plan quality. On average, plans in both the QIA and RFI datasets realized improvements in key diabetes indicators. However, it is not feasible to determine how much of this improvement can be attributed to the QI or DM initiatives. While MCOs claim to offer DM programs, differences in program characteristics suggest that the application of DM is highly variable from plan to plan.