Challenging the Status Quo in Chronic Disease Care: Seven Case Studies

Robert A. Berenson, MD, The Urban Institute

The culture, structure, and financial incentives of most medical practices limit providers' ability to best treat chronically ill patients. This research explores approaches that avoid the shortfalls of two prototypical strategies.

September 2006

Physicians often lack the time, resources, and financial incentives to systematically improve the quality of care for patients with chronic conditions. They must also contend with barriers to innovation, like traditional Medicare payment policies that pay for treating acute problems rather than serious underlying conditions.

This 2006 report features case studies of seven strategies for managing and improving chronic disease care. It examines unique, provider-based strategies that fall outside the prototypical models of disease management and clinic-based chronic care. The report looks at the benefits, limitations, and policy implications of these alternative approaches.

Researchers had two main objectives: to identify provider-based approaches to chronic disease care that realistically consider what physicians are willing and able to do to modify their practices, and to better explain the barriers to innovation and how exemplary organizations managed those challenges.

Among the report’s nine major findings are:

  • Physicians and hospitals can do much more to manage patients with chronic diseases
  • There are viable models that fall between the prototypical strategies of the Chronic Care Model and third-party disease management vendors
  • Capitation is more compatible with chronic care programs and their patient populations than fee-for-service reimbursement

While the full report provides summaries of the seven case studies, the appendix includes more details, including how each organization developed its program, its components, lessons learned, and policy implications.

The full report and appendix are available under Document Downloads.