progress assessment. These reports can serve as the basis for determining whether and where structural
improvements are needed. Feedback loops are also created in disease management programs through open-lines of
communication between the patient and his disease management team. By discussing care with individual patients,
the teams can determine if changes in the program are necessary to meet a patient's needs and disease management
goals.
Although disease management programs primarily espouse a desire to achieve quality, they also indirectly can
achieve equality in healthcare by reducing racial disparities.
[FN49]
The uniform clinical care provided to all
patients involved in a disease management program can reduce disparate provision of healthcare due to
socioeconomic status, race or ethnicity. Because every individual is receiving care derived from the same evidence-
based guidelines, there is little room for conscious or unconscious biases to affect the quality of care.
[FN50]
The
creation of information systems infrastructure and systematic monitoring further diminishes the possibility for
variation in the provision of healthcare on the basis of either conscious or
*403
unconscious biases. Finally, the shift
in focus towards chronic care diseases has a positive effect, especially for racial and ethnic minorities.
B. REFORMIST INSTITUTIONS: TWO EXEMPLARY PROJECTS
Healthcare systems are implementing programs to provide equitable healthcare via a disease management
approach. The Health Disparities Collaboratives and programs within certain physician-led managed care systems
are two exemplary projects that have adopted this method. The Health Disparities Collaboratives demonstrates a
shift to a disease management approach within the community health center system that has traditionally served
racial and ethnic minorities. Physician-led managed care organizations have also embarked on emphasizing quality
by creating disease management programs to improve outcomes, to attract patients and to provide cost-effective
service.
1. Community Health Center Based System
The federally funded Health Disparities Collaboratives is a comprehensive initiative to address racial, ethnic and
socioeconomic health disparities through disease management.
[FN51]
This program is part of the Healthy People
2010 Campaign to (1) increase the quality of healthy life for all Americans and to (2) eliminate health disparities
through the use of evidence- based medicine, which entails incorporating key scientific findings into medical
practice and measuring the associated outcomes.
[FN52]
a. Background
The Health Resources Services Administration (HRSA) created the Health Disparities Collaboratives program. In
the late 1990s, HRSA sought to improve healthcare quality and outcomes at community health centers, which serve
predominantly low-income, racial and ethnic minority populations.
[FN53]
Using the
*404
Collaborative Chronic
Care Model for disease management, developed by the Institute for Healthcare Improvement (IHI) and the MacColl
