Heiser N A, St Peter R F
Mathematica Policy Research, Inc, Washington, DC 20024-2512, USA.
Jt Comm J Qual Improv. 1997 Oct;23(10):529-47. doi: 10.1016/s1070-3241(16)30338-8.
In February-October 1996 a case study analysis was conducted to examine the key features of prevention programs for women in six managed care plans and one group medical practice. These programs, which use either data-based or office-based strategies, are considered by experts in the field to be exemplary.
Prevention programs for the case study were identified through a literature review and discussions with knowledgeable individuals about prevention programs and managed care. Information was collected about breast and cervical cancer prevention programs through written materials and telephone interviews with staff. Given limited and noncomparable information, relative program effectiveness was not assessed.
The case study programs use many types of data to support prevention strategies such as patient reminders and performance feedback to providers. Successful programs require substantial resources and planning; are population based; gain the support of providers and patients early; have clear, established systems for collecting and using data; and have a monitoring and evaluation component. The challenges that remain for managed care plans are balancing the need for prevention programs with limited resources, using imperfect data to support interventions, developing effective strategies for reaching high-risk populations, and working with large networks of providers.
Managed care plans have great potential to use their information systems and organizational structure to support prevention efforts. The extent to which these opportunities are realized depends on managed care plans' progress in developing their broader information management systems and on purchasers' demands for these types of programs.
