One of the continuing areas of focus of health plans is the improvement of clinical services to ensure quality of service delivery, good patient outcomes and lower health care costs. This paper reports on a study conducted to measure baseline levels of performance in clinical monitoring and follow-up of two target populations: adults with diabetes, and adults with hypertension. These populations are known to be at risk for health problems and high costs, and it is widely recognized that effective control of these chronic conditions requires intensive clinical monitoring and follow-up. A sample of medical records of physicians who participate in a network of a single health plan were reviewed to determine physician practice patterns with patients having the primary diagnosis of diabetes (n=320) or hypertension (n=265). Findings demonstrate variation among physicians in their monitoring of these two clinical conditions. Implications for provider education and plan performance are discussed within a suggested framework for quality improvement.
Learning Objectives: At the conclusion of this session, participants will be able to: 1) understand the importance of health plan monitoring of network physician services 2) understand techniques for monitoring performance 3) recognize how to use information derived from monitoring in a quality improvement effort
Keywords: Managed Care, Quality Improvement
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.