Diabetes and the Promise of Managed Care

Abstract

The term managed care has a positive connotation to many people and a negative connotation to others. It implies a systematic approach to the provision of care supported by a managed care organization, the underlying values of which are efficiency in care delivery and continuous health improvement of the population being served. The recent advances in knowledge surrounding the treatment of diabetes, the codification of these advances into treatment guidelines, and the significant gap between recommended and real-world treatment patterns all suggest that there is an opportunity for managed care organizations to play a beneficial role in improving the treatment of people with diabetes. Typical strategies used by managed care organizations include dissemination of treatment guidelines and information feedback to providers and patients to suggest diagnostic measures or therapeutic interventions that should be repeated with regularity to maintain or improve the health of people with diabetes. Improvements in population-level measurement of health care quality will increase the focus on preventable long-term complications of diabetes and other chronic diseases and may establish increasingly quantitative quality metrics that should improve real-world treatment patterns. Models exist for a multifaceted approach to improve the care of people with diabetes through such mechanisms; this article reviews the experience of one health plan with such undertakings.