Management of multiple sclerosis across managed care and fee-for-service systems

Objective: To measure and compare care for adults with MS across managed ca re and fee-for-service (FFS) health systems. Methods: The authors sampled a dults with MS having physician visits over a a-year period from a group mod el health maintenance organization (HMO) in southern California, from a mid western independent practice association (IPA) model managed care plan, and from the FFS portion of the practices of a random sample of southern Calif ornia neurologists. The authors mailed surveys to subjects in mid-1996; 930 of 1,164 (80%) of those eligible responded. The authors measured sociodemo graphic and clinical characteristics, management of recent changes in mobil ity, bladder control, and fatigue, use of a disease-modifying agent, assess ment of general health symptoms and issues, and unmet information needs. Th e authors adjusted comparisons between systems for comorbidity, disease sev erity, and disease type. Results: The groups differed on most sociodemograp hic and clinical characteristics. There were few differences in symptom man agement; differences that did exist tended toward more referrals or treatme nt for the FFS group. Access to the disease-modifying agent available at th e time of the survey did not differ across systems, although patients' perc eptions of the rationale for not using the drug did vary. General health is sues and symptoms were more often assessed in the FFS and IPA systems than in the HMO, but improvement was needed across all three systems of care. Th ere were substantial unmet information needs in all groups and especially h igh ones in the FFS and HMO samples. Conclusions: Strategies to improve car e for people with MS should be developed and evaluated, particularly in are as like symptom assessment and meeting patient information needs. Where var iations in service delivery exist, longitudinal studies are also needed to evaluate the potential impact on outcomes and to evaluate reasons for varia tion.