Different approaches to disease management in a managed care organization: Lessons learned

The objective of this study was to contrast the outcomes obtained from different approaches to diabetes disease management in a managed care organization (MCO). Three different programs were developed. The Diabetes Quality Initiative (DQI) used extensive physician and patient education opportunities, guideline dissemination, and improved access to specialty care. The Diabetes Retinal Eye Screening Program (DRESP) included reminders to patients and providers about the need for eye care with direct physician feedback. The Diabetes Advantage Program (DAP) was a 12-month primary care-based trial that used an information system to facilitate patient tracking. A care coordinator and RN care manager were given expanded roles in the management of patients. Diabetes indicators were measured to evaluate each of these programs. The DQI produced small but significant increases in frequency of A1c, LDL, and creatinine measurement. Glycemic control worsened. The DRESP produced a short-term increase in eye visit rates but no sustained improvement. DAP data at 12 months on 193 patients showed dramatic improvements. One hundred percent of participants had A1c, creatinine, and microalbumin determinations. Eighty percent had eye exams. Glycemic, lipid, and blood pressure control improved. Success was realized with a clinic-based approach, utilizing a care team supported by an information strategy that allowed individualized risk assessment and personalized treatment plans. The interventions used in the DQI and DRESP proved weak or ineffectual. MCOs should rethink their approach to disease management and support innovations that bring the requirements of chronic disease management to the physician's office.