The Role of Disease Management in Pay-for-Performance Programs for Improving the Care of Chronically Ill Patients

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Eric W. Ford, Professor (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Abstract: To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient out-comes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health’s eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

The Role of Disease Management in Pay-for-Performance Programs for Improving the Care of Chronically Ill Patients
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Additional Information

Publication

Beich, J. J., Scanlon, D. P., Ulbrecht, J., Ford, E. W., and Ibrahim, I., (2006). The Role of Disease Management in Pay-for-Performance Programs for Improving Care of Chronically Ill Patients. Medical Care Research & Review. Volume 63(1), pp. 96S-116S.

Language: English

Date: 2006

Keywords

disease management, diabetes, pay for performance, managed care, chronic conditions

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