Planning for a Managed Care Plan that Welcomes Specialists

Management of chronic disease in the employed population

During 1992 and 1993, staff at the Johns Hopkins Health System created a plan to develop and market a managed care product offering capitated specialist care for the employed chronically ill.

If found feasible, the grantee wanted to implement the project at the Johns Hopkins Health System. The project team hoped to demonstrate in an implementation project that their product could result in cost savings, higher quality care, greater patient satisfaction and less work loss.

Key Results

  • The planning phase produced a full-scale implementation plan with the following four key components:

    • Clinical team and treatment protocols for four chronic conditions:
      • Diabetes.
      • Affective disorders.
      • Chronic cardiovascular conditions including hypertension.
      • Musculoskeletal diseases including back pain.
    • A delivery system integrating five clinical elements:
      • Specialist physicians.
      • Nurse specialist-gatekeepers.
      • Primary care providers.
      • An experienced third-party administrator.
      • Other referral resources and emergency procedures for services outside the plan's providers.
    • A marketing plan based on focus groups conducted of employees with chronic diseases, assessing their needs and barriers to their enrollment in the proposed delivery system.
    • An evaluation plan to determine if this managed, capitated health care delivery model would be effective in yielding lower annual per-patient costs of care, greater patient satisfaction, better quality of care and decreased employee work loss.