A survey of asthma care in managed care organizations - Results from the Chicago Asthma Surveillance Initiative

Introduction: Managed care, both tia staff model health maintenance plans a nd nonstaff model plans, has become a major source of health-care funding i n the United States. However, very little is known about the asthma-specifi c products and services offered by these plans, The purpose of this study i s to examine the asthma-specific products and services offered by managed c are within the Chicago area. Methods: Between December 1997 and February 1998, a self-administered sun e y was mailed to the medical directors of the 19 managed care organizations (MCOs) in the Chicago area. The survey covered the following; content areas : general characteristics of the MCOs, asthma-related services, monitoring of asthma care, and asthma-related quality improvement efforts. The medical directors were asked to respond separately for staff model capitated plans , nonstaff model capitated plans, and noncapitated plans. Results: Responses were received from 13 of the 19 eligible Chicago-area MC Os (a response rate of 68.4%). Three of the responding MCOs (23.1%) offered a staff model plan, 11 (84.6%) offered a nonstaff model capitated plan, an d 6 offered some type of noncapitated plan. Asthma education programs, alth ough available in all plan types, were offered much less frequently in the nonstaff model capitated and noncapitated plans, 36.4% and 33.3%, respectiv ely. Asthma case management programs were also available in some, but not a ll of the health plans. Only 54.5% of the nonstaff model capitated health p lans promoted the use of asthma practice guidelines. Among the responding M COs, asthma quality improvement efforts related to National Committee on Qu ality Assurance accreditation were infrequent in 1995, Sixty-one percent of the MCOs reported that program development for improving asthma care was a very high priority relative to programs for other health conditions. Conclusion: The results of this study suggest that many but not all, of the basic elements of asthma care services are offered by the MCOs in the Chic ago area. Findings from this study also suggest ways in which asthma-relate d product and service delivery might be changed to improve outcomes for ast hma in this community.