2003_02 | NEWS: Plans' support needed in reaching IOM's goals

MANAGED CARE EXECUTIVE EDITION February 2003. ©MediMedia USA

NEWS AND COMMENTARY

Plans’ support needed in reaching IOM’s goals

When the Institute of Medicine unveils a report on how to improve the health care system, nearly everyone takes notice. The Institute’s latest study, Priority Areas for National Action: Transforming Health Care Quality, includes recommendations that could have an impact on managed care.

The report voices the frustration felt by many experts and laymen these days in saying that the U.S. has the “knowledge and capacity to deliver the best care in the world” but doesn’t.

The problem is that the knowledge isn’t translated into clinical practice, the authors contend.

The IOM suggests that the system should focus on 20 priority areas, ranging from broad interventions, to preventive services, to servicing the frail elderly, to palliative care for the dying.

One of those areas is care coordination, in which providers and institutions, such as HMOs, are encouraged to collaborate in providing the right care to about 60 million Americans who live with multiple chronic diseases.

“For those afflicted by one or more chronic condition, coordination of care over time and across multiple health care providers and settings is crucial,” the authors write. “Yet, in a survey of over 1,200 physicians conducted in 2001, two thirds of respondents reported that their training was not adequate to coordinate care or education for patients with chronic conditions.”

Another of the 20 priority areas, diabetes, is a prime candidate for disease management, not least because it “predisposes individuals to many long-term, serious medical complications, including heart disease, stroke, hypertension, blindness, kidney disease, neurological disease, and increased risk of lower-limb amputation.”

The IOM notes the work being done at HealthPartners, a consumer-governed health plan and integrated system in Bloomington, Minn.

“Key components of the HealthPartners diabetes program include a diabetes registry that provides clinicians with automated reminders for needed services; use of interdisciplinary teams including physicians, diabetes nurse specialists, social workers, and mental health professionals; education programs, including counseling on diet and exercise; and implementation of a staged approach to diabetes management, with an action plan and timeliness for stepping up care to meet therapy goals.”