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United HealthCare Corp. in Minneapolis has created clinical profiles that give physicians who treat the health plan’s members some benchmarking information for their practices.
More than 20,000 cardiologists, internists, and family practitioners participating in 23 of United HealthCare’s health plans received the reports in September and October 1998.
The managed care organization (MCO) compiled the profiles this way:
• The profiles are distributed to physicians in the areas of family practice, internal medicine, pediatrics, and cardiology.
• A team of medical professionals wrote the criteria for the profiles using existing standards prepared by specialist groups. Data is reported from claims and is supported by literature in agreement with specialty groups and national organizations.
• The profiles only cover conditions upon which doctors agree upon a standard of care.
• The clinical profiles focus on conditions of risk or prevalence that could result in high-cost problems.
• The second round of reports, scheduled for early 1999, will include pediatrics Reporting will be expanded to include glycated hemoglobin testing for diabetic children, the timely delivery of immunizations, effective use of corticosteroids in treating asthma, and consensus treatment for ear infections.
The first six indicators are as follows:
1. Atrial fibrillation, which affects 5% of people over age 65 and places them at a high risk for stroke;
2. Acute myocardial infarction or heart attack;
3. Congestive heart failure: Research has shown that prescribing ACE inhibitors can ease symptoms and slow the disease’s progression;
4. Diuretics: Patients on these drugs may suffer dangerous loss of potassium;
5. Mammography screening, which can reduce the risk of death from breast cancer by one third in women over 50 years of age;
6. Glycated hemoglobin tests, which is important for helping diabetics control their disease.