Initial experiences in managed care have demonstrated that disease management approaches that incorporate targeted case management and quality management in addition to physician training and outreach can significantly improve quality and reduce the costs of care for certain populations with chronic illness. These efforts have initially been focused on high-incidence or high-cost groups such as those persons with diabetes, asthma, depression, or high-risk pregnancy. Some programs address children with chronic illness. For example, Greineder et al1 demonstrated that selected high-risk children with asthma who were enrolled in an outreach program operated by the Harvard Community Health Plan, Boston, Mass, achieved reduced rates of hospitalization, reduced rates of emergency department utilization, and improved quality of care. The program used a registered nurse working approximately 8 hours per week, which represented an annual cost of $11,115 in 1993. The program generated a savings of $76,200 per year or an almost 8:1 ratio of savings to costs.
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