Excerpt

Little information exists on the number of adults under age 65 with significant chronic conditions who are enrolled in managed care plans. Even less is known about differences in outcomes of care of individuals with chronic conditions across the array of managed care models. The present study grew out of the desire of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) to convene significant stakeholders and researchers to determine what information can be gleaned from existing data and delineate the key research questions needed to address concerns regarding the effect of the changing health care system on the quality of care for individuals with chronic conditions, particularly chronic rheumatic diseases. Specifically, the Institute of Medicine (IOM) was charged with planning and conducting a workshop focused on the following questions:

1. Does the model of managed care or integrated delivery system (e.g., fully capitated managed care, gatekeeper-only model of managed care, discounted fee for service) influence (a) the types of interventions provided to patients with chronic conditions and (b) the clinical and health status outcomes of those interventions?

2. If so, are these effects quantitatively and clinically significant, as compared to the effects that other variables (such as income, education, or ethnicity) have on patient outcomes?

3. If the mode of health care delivery system appears to be related to patient care and outcomes, can specific organizational, financial, or other variables be identified to account for the relationships?

4. If not, what research agenda should be pursued to provide critical information about the relationship between types of health care systems and the processes and outcomes of care delivered to populations with serious chronic conditions?