Quality of Chronic Disease Managed Care Target of Joint AHCPR-Private Sector Research Effort

Press Release Date: September 19, 1997

The Agency for Health Care Policy and Research (AHCPR)—the federal research agency charged with finding ways to improve health care delivery—and the American Association of Health Plans' Foundation today announced a joint call for studies to determine the impact of different features of health plans on the quality of care provided to patients with chronic illnesses and on outcomes. The foundation is the research arm of the American Association of Health Plans (AAHP), a national organization representing over 1,000 health plans that serve approximately 140 million Americans.

In making the announcement, AHCPR Administrator John M. Eisenberg, M.D., M.B.A., said his agency and the foundation will together provide up to $7 million over a three-year period to support peer-reviewed, outcomes-focused studies.

"Research has moved beyond questions of differences between managed and fee-for-service care or between types of health maintenance organizations. We are now focusing on how changes in organizational structures and care models being developed by health plans impact patient health," said Dr. Eisenberg, who added that the collaborative effort provides a framework for impartial, scientifically rigorous studies.

Over 80 percent of privately insured Americans now depend on some form of managed care for their health needs, as do roughly 30 percent of Medicaid recipients and nearly 14 percent of Medicare beneficiaries. The two latter groups have the highest incidence of chronic illnesses—the focus of this research.

"This joint, fast-track research effort will get the answers we need; the next steps will be finding ways to address problems and share and replicate successes," Dr. Eisenberg said. He added that AHCPR will widely disseminate the results of the studies to consumers, health plans, purchasers, health care practitioners and policymakers, as well as the research community.

Karen Ignagni, M.B.A., AAHP's president, said, "This research, which addresses quality and outcomes of care for people with chronic diseases, will focus on special populations, including women, minorities and the elderly, and will serve as a catalyst to encourage cooperative research with others who have a commitment to this mission." Ms. Ignani added that this industry-wide research supplements the ongoing research of AAHP's individual member plans and has the potential to greatly benefit millions of Americans.

Although research to date has not been sufficiently sensitive to variations in quality or outcomes that may result from specific features of health plans, studies have uncovered a number of challenges for both managed and fee-for-service plans. These include the need for greater compliance with well-established guidelines for caring for patients with chronic illnesses and the need to assess chronically ill patients' understanding of their condition and examine their functional ability.

The new research solicitation calls for studies focusing on widespread chronic conditions or aggregations of conditions, especially if they have a disproportionate impact on children, women, minorities or the elderly. Health plan features that researchers may want to study because they may affect performance include the availability of specialists and subspecialists, types of providers involved in primary care, and methods for influencing provider practice, including risk-sharing.

After the approved proposals are funded, the principal investigators will meet to develop some common questions and coordinate approaches so that findings can be as broadly applicable as possible to managed care organizations and/or chronic conditions.

Applications must be received no later than January 6, 1998.

For questions about the research, contact Dr. Bernard Friedman, (301) 427-1674 (BFriedma@ahrq.gov), of AHCPR's Center for Organization and Delivery Studies.

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov), Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov); or Susan Pisano, AAHP, at (202) 778-3245.