Organization and Financing of Diabetes Care

One of the theme areas of the Prevention and Control Core is determining which forms of organizing and financing health care can improve the provision of high-quality, cost-effective diabetes care. An example of a current study that informs this effort is led by Willard Manning, PhD, and funded by the Robert Wood Johnson Foundation. This study examines the effect of a natural experiment in utilization review (UR) and utilization management (UM). In 1999, United Health Care (UHC), a major private managed care company, terminated its UR program for inpatient care. This newly funded study will use pre and post data on patients, including those with diabetes, to assess the impact on health care utilization and costs on both an inpatient and outpatient basis, as well as the impact on process quality of care measures.

The past two decades have seen the rise of multiple, complicated ways of organizing and financing care including variants of managed care, preferred provider organizations, independent practice associations, chronic disease management systems, and utilization review. Little work has examined how these fundamental ways in which health care is organized have affected the outcomes and costs of patients with diabetes. Utilization review is one of the basic organizational mechanisms to study. First adapted on a widespread basis in the late 1980s, UR was one of managed care’s most celebrated and controversial ways of reducing costs. Early research indicated substantial health care savings from such programs. To date there have been no studies of mature UR programs or studies that did not involve innovating firms. Few follow-up studies were done, and there was little research on the impact of UR on quality of care. This study involves both a mature program and the analysis of quality of c are information for patients with diabetes.