Diabetes in the managed care setting: a prospective plan

South Med J. 1999 May;92(5):459-64. doi: 10.1097/00007611-199905000-00002.

Abstract

Background: As managed care organizations (MCOs) continue to expand into the care of the chronically ill, the concept of providing cost-effective care with a preventive approach is vital for primary care providers (PCPs) to embrace. Diabetes is an ideal disease to incorporate this concept.

Methods: We reviewed the literature using MEDLINE. We used the American Diabetes Association (ADA) Provider Recognition Program guidelines as the foundation for MCOs to establish a diabetes disease management program.

Results: The implementation of disease management protocols, the use of computerized management systems, and the team approach can provide cost-effective diabetic care.

Conclusions: To compete in the managed care market, it is vital for providers to link with their Independent Practice Associations (IPA), the ADA, and MCOs to implement standard protocols and negotiate for adequate reimbursement.

Publication types

  • Review

MeSH terms

  • Diabetes Mellitus / therapy*
  • Health Planning Guidelines
  • Humans
  • Independent Practice Associations
  • Managed Care Programs* / legislation & jurisprudence
  • Managed Care Programs* / trends
  • Patient Care Team
  • Therapy, Computer-Assisted