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AHCPR Teams with AAHP Foundation to Improve Care for the Chronically Ill

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Press Release Date: June 22, 1998

Millions of chronically ill Americans who depend on managed care plans for their care will benefit from new studies announced today. HHS' Agency for Health Care Policy and Research (AHCPR) and the American Association of Health Plans Foundation (AAHPF), the research arm of the nation's largest managed care trade association, together with AHCPR's sister agency, the Health Resources and Services Administration (HRSA), have awarded six research teams a total of $8.5 million over three years.

The research will determine how particular managed care policies and practices, such as protocols governing the referral of patients to medical specialists and arrangements for paying physicians, affect the quality of care for patients living with chronic illnesses. The six teams, which were selected through AHCPR's peer review process from a pool of over 30 applicants, will be drawn from scientists working at some of the top research institutions in the country.

In their announcement, AHCPR administrator, John M. Eisenberg, M.D., and Karen Ignagni, AAHP president and CEO, said the studies will provide health plan executives and purchasers, including government, with the first comprehensive findings regarding which policies and procedures can be adopted by managed care organizations to optimize effective health outcomes.

The last generation of research in this area focused on general comparisons between managed care and traditional fee-for-service plans. The main lessons learned from those studies are that both types of plans can do a better job taking care of people with chronic conditions, and that what is needed most is evidence on how specific strategies for managing and financing care affect quality.

"The question that puzzles Americans today is not whether fee-for-service or managed care is better," said Dr. Eisenberg. "The question is whether there are some aspects of managed care that are helpful and some that are harmful, especially to those people with chronic diseases. These studies will provide evidence-based research that will help us answer these kinds of questions." An estimated 90 million Americans—one of every three persons in the United States—has one or more chronic conditions. These conditions account for one of every six dollars spent on health care.

"This groundbreaking research effort is built upon a public and private partnership dedicated to furthering the goal of developing evidence-based care," said Ms. Ignagni. "We thank our health plans for their commitment and also thank the Prime Health Foundation in Kansas City for being an early partner in this unique research effort across plans representing a variety of approaches to delivering health care."

The research teams will examine data and patient records from 32 health plans, over 50 local medical group practices affiliated with one of the nation's largest health care purchasing cooperatives—organizations funded by employers to negotiate health coverage for workers—and several government-sponsored programs. Together these groups provide health care for over 10 million Americans from California to Massachusetts. The study populations represent a cross-section of Americans, including persons of low income, who live with chronic illnesses.

"Poor, uninsured Americans—especially racial and ethnic minorities—are the people most likely to have chronic illnesses and least likely to have access to care needed to manage their condition," said Claude Earl Fox, M.D., M.P.H., administrator of HRSA. "Finding out how we can use managed care practices to improve health outcomes will help us assure longer, better lives for millions of Americans, especially children with special needs."

The following grants were awarded:

  • Jose Escarce, M.D., Ph.D., RAND, Santa Monica, CA, will study the care given to working-age members of seven United Health Care plans in different parts of the country for diabetic retinopathy and open-angle glaucoma—both of which are leading causes of blindness.
  • Edward Guadagnoli, Ph.D., Harvard Medical School, Cambridge, MA, will examine care for diabetic and hypertensive patients enrolled in the plans of Health Partners, Preferred One and Allina in the Minneapolis-St.Paul area.
  • Katherine Kahn, M.D., University of California, Los Angeles, will analyze quality of care provided to patients with chronic heart and lung diseases by 58 group practices serving companies who belong to the Pacific Business Group on Health.
  • Tracy Lieu, M.D., Kaiser Permanente of Northern California, Oakland, CA, will examine the quality of care given to asthmatic children enrolled in Medicaid managed care plans in California, Massachusetts and Washington State.
  • Barbara McNeil, M.D., Harvard Medical School, Cambridge, MA, will focus on members of Prudential, Allina, United Health Care and Pacificare treated for heart attack, congestive heart failure or hypertension.
  • Elizabeth Shenkman, Ph.D., University of Florida, Gainesville, FL, will study the quality of care for low-income children in Florida's Healthy Kids Program who suffer from asthma, diabetes or other problems. Participating groups include the Health Insurance Plan of Florida, Health Option/Blue Cross-Blue Shield of Florida, Humana, Florida Health Care Plans, Florida First, PCA Family (Physicians' Corporation of America-Family), JMH Health Plan of Florida (Jackson Memorial Trust Plan of Florida), Av-Med Health Plan and Physicians' Health Plan.

The new studies are part of a broad AHCPR effort to build a foundation of scientifically sound evidence that can be used to help make clinical, public policy, and health care system decisions related to the quality of care.

Note to Editors: The 32 health plans participating in this research effort include: Allina Health Systems, Health Partners, Preferred One, United Health Care, Pacificare, Prudential, Humana, Health Insurance Plan (HIP) of Florida, Health Options/Blue Cross Blue Shield of Florida, Florida Health Care Plan, Florida First, PCA Family (Physicians' Corporation of America-Family), JMH Health Plan of Florida (Jackson Memorial Trust Plan of Florida), Av-Med Health Plans, Physicians' Health Plan, Kaiser Permanente, Group Health Cooperative, CareNet, Harvard Pilgrim, North Bay Health, Solana Private Providers, Solano Community Clinics, Harvard Vanguard, and Neighborhood Health Plan.

Addendum: In September 1998, AHCPR awarded a grant to Bruce C. Stuart, Ph.D., University of Maryland at Baltimore, bringing the total number of grants awarded in this effort to seven. The research team will study the impact of managed care organization policies on health outcomes for asthmatic children under Medicaid after Maryland introduced mandatory managed care enrollment for certain Medicaid recipients in 1997.

For additional information, please contact AHCPR Press Office: Salina V. Prasad, (301) 427-1864 (SPrasad@ahrq.gov); AAHP Communications: Don White (202) 778-3274.

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