Chronic disease medication use in managed care and indemnity insurance plans
Authors
Stafford, Randall S.Davidson, Stephen M.
Davidson, Harriet
Miracle-McMahill, Heidi
Crawford, Sybil L.
Blumenthal, David
UMass Chan Affiliations
Department of Medicine, Division of Preventive and Behavioral MedicineDocument Type
Journal ArticlePublication Date
2003-06-06Keywords
AdultAged
Asthma
Chronic Disease
Cross-Sectional Studies
Diabetes Mellitus
*Drug Utilization Review
Fee-for-Service Plans
Female
Heart Failure, Congestive
Humans
Independent Practice Associations
Insurance Claim Review
Logistic Models
Male
Managed Care Programs
Middle Aged
Physician's Practice Patterns
United States
Preventive Medicine
Metadata
Show full item recordAbstract
OBJECTIVE: To evaluate the impact of managed care on the use of chronic disease medications. DATA SOURCE: Claims data from 1997 from two indemnity and three independent practice association (IPA) model managed care insurance plans. RESEARCH DESIGN: Cross-sectional analysis of claims data. DATA COLLECTION: Adult patients with diabetes mellitus (DM, n = 26,444), congestive heart failure (CHF, n = 7,978), and asthma (n = 9,850) were identified by ICD-9 codes. Chronic disease medication use was defined through pharmacy claims for patients receiving one or more prescriptions for drugs used in treating these conditions. Using multiple logistic regression we adjusted for patient case mix and the number of primary care visits. PRINCIPAL FINDINGS: With few exceptions, managed care patients were more likely to use chronic disease medications than indemnity patients. In DM, managed care patients were more likely to use sulfonylureas (43 percent versus 39 percent for indemnity), metformin (26 percent versus 18 percent), and troglitazone (8.8 percent versus 6.4 percent), but not insulin. For CHF patients, managed care patients were more likely to use loop diuretics (45 percent versus 41 percent), ACE inhibitors or angiotensin receptor blockers (50 percent versus 41 percent), and beta-blockers (23 percent versus 16 percent), but we found no differences in digoxin use. In asthma, managed care patients were more likely to use inhaled corticosteroids (34 percent versus 30 percent), systemic corticosteroids (18 percent versus 16 percent), short-acting beta-agonists (42 percent versus 33 percent), long-acting beta-agonists (9.9 percent versus 8.6 percent), and leukotriene modifiers (5.4 percent versus 4.1 percent), but not cromolyn or methylxanthines. Statistically significant differences remained after multivariate analysis that controlled for age, gender, and severity. CONCLUSIONS: Chronic disease patients in these managed care plans are more likely to receive both inexpensive and expensive medications. Exceptions included older medications partly supplanted by newer therapies. Differences may be explained by the fact that patients in indemnity plans face higher out-of-pocket costs and managed care plans promote more aggressive medication use. The relatively low likelihood of condition-specific medications in both plan types is a matter of concern, however.Source
Health Serv Res. 2003 Apr;38(2):595-612.
DOI
10.1111/1475-6773.00135Permanent Link to this Item
http://hdl.handle.net/20.500.14038/50774PubMed ID
12785563Related Resources
ae974a485f413a2113503eed53cd6c53
10.1111/1475-6773.00135