With health care today being a collaborative effort among providers, patients, and payers, the paradigm of care delivery has changed. Providers want autonomy but are increasingly being held to evidence-based and population-based standards. Payers are demanding this accountability, but the managed care backlash has forced them to refrain from micromanaging providers. Many patients, meanwhile, see personalized health care as a right — even as employer cost-sharing tactics bestow patients with a responsibility to exercise cost-conscious decision making. The presentations in this supplement, derived from the 12th Annual Symposium for Managed Care Professionals, explore the issues inherent in this transforming environment.
- Health Status, Health Maintenance, and Health Care in the 21st Century
- Health Care Reform: Payer, Provider, Patient
- Health Care Reform: The Consumer’s Viewpoint
- Changing the Public’s Image of Managed Care
- Treating Diseases and Managing Cost
- Special motivational presentation: The Power of Perspective
This monograph, written in 2000 by Cary Sennett, MD, PhD, is a description of the National Committee for Quality Assurance's HEDIS hypertension measure, as promulgated that year. The material also includes a discussion of the importance of hypertension control and the need to monitor providers carefully. The implementation of this measure created challenges for health plans, in terms of both performance measurement and performance improvement. The information provided herein is intended to help leaders in managed care plans prepare for those challenges, by providing a greater understanding of the problem of hypertension control, then explaining how measurement can help improvement efforts, what strategies might be helpful, and what implementation might require. The article is drawn from a summit that brought researchers together with health plan medical directors, pharmacy directors, and quality assurance directors to share knowledge and develop recommendations for others.
- The HEDIS Hypertension Measure
- Implementing the Measure
- Beyond HEDIS: Measuring Progress in Your Organization
- Implications for Medical, Pharmacy, and Quality Assurance Directors
Diabetes affects 16 million Americans at an annual cost of nearly $100 billion. One third of those with diabetes are undiagnosed, while a substantial portion of those with diagnosed disease are undertreated — with staggering clinical and economic implications. This supplement discusses pharmacological options for treatment, the National Committee for Quality Assurance’s role in helping health plans to provide adequate care for its diabetic members, and a case study of a successful diabetes disease management program. The information herein derives from a meeting attended by physicians, pharmacists, health plan medical and pharmacy directors, employers, pharmacy benefit managers, and quality assurance experts.
- Diabetes Prevalence and Economic Implications
- Comprehensive HEDIS Measures for Diabetic Patients
- Management of Type 2 Diabetes: Update on New Pharmacological Options
- A Disease Management Approach to Type 2 Diabetes
- Roundtable Discussion: The Future of Diabetes Treatment
Patients' failure to adhere to medication regimens is a major problem. The factors that beget nonadherence are complex and interwoven. Patients' ability to understand their treatment routines or the reasons for them, side effects, financial barriers, simple forgetfulness — or any combination of these and myriad other determinants — can influence adherence to therapy. Removing barriers to adherence ultimately improves the potential for positive clinical and financial outcomes.
- A Retrospective Study of Persistence With Single-Pill Combination Therapy vs. Concurrent Two-Pill Therapy in Patients With Hypertension
- Medication Noncompliance: What Is the Problem?
Atherosclerosis is a contributing factor to heart attack, stroke, or peripheral arterial disease. These overlapping disease states are linked by common risk factors and a shared pathophysiologic factor, the platelet. Antiplatelet therapy, therefore, may help to reduce the risk of vascular events and thereby lessen the morbidity, mortality, and cost associated with atherosclerosis and its consequences. The material in this publication stems from a panel discussion of experts in neurology, cardiovascular medicine, and vascular medicine, along with representatives of leading MCOs. Their goal was to reach a consensus on use of antiplatelet therapy within a managed care environment. Clinical pathways for therapy related to myocardial infarction, stroke, and peripheral arterial disease were developed by consensus of the panel and are presented herein. Lawrence M. Brass, MD, of Yale University and Randall Zusman, MD, of Harvard University co-chaired the meeting.
- Clinical and Economic Implications of Atherosclerosis
- Antiplatelet Therapy: A Perspective From Cardiology
- Antiplatelet Therapy: A Perspective From Vascular Medicine
- Antiplatelet Therapy: A Perspective From Neurology
Health care was one of the major themes of the 2000 presidential election season. The presentations at the 13th Annual Managed Healthcare Symposium, just prior to the 2000 election, capsulated the political, economic, and social implications of the health care issues that the current administration in Washington now faces and that are still relevant as the 2004 elections approach. These presentations, adapted for this supplement, include discussions of consumer expectations, the uninsured, Medicare reform, employer concerns, and a frank keynote debate between Paul Begala and Robert Novak. The important issues discussed in this supplement will be of interest to health plan medical and pharmacy directors, pharmacists, pharmacy benefit managers, employers, and quality assurance experts.
- The Presidential Election and Its Effect on Health Care (Begala/Novak)
- The Employer’s View of Health Care
- Health Care in the Information Age
- Issues That Will Determine Health Care’s Future
- Panel Discussion: Solutions to Health Care Issues
- Special motivational presentation: Humor, Risk, and Change