The Role of Disease Management in Pay-for-Performance Programs for Improving the Care of Chronically Ill Patients

The current investigation examined pay-for-performance (P4P) and disease management (DM) approaches to health care. Fifty diabetes DM programs that were a part of the 2002 Diabetes Management segment of the National Business Coalition on Health's eValue8 Request for Information (RFI) project were evaluated. The study outcomes were the HEDIS Comprehensive Diabetes Care indicators.

Key Findings:

  • Slightly more than half of the health care plans varied in how they implemented DM approaches with more variation in areas such as Practitioner Interventions and less variation in domains such as Patient Registry.
  • Approximately two-thirds of the plans gave primary care physicians diabetes guideline adherence reports. Thirty percent of plans gave physicians monetary incentives for adhering to guidelines.
  • Almost all of the plans (98%), put diabetes guidelines in place and just over half (54%) collaborated in some way on the guidelines.
  • Regression analyses indicated that the structure and process of DM programs was not strongly or consistently related to HEDIS indicators of diabetes care.