A state commission plans to unveil a proposal today that invites doctors, patients and insurers to embrace a different vision for treatment of chronic diseases such as diabetes.

Among other recommendations, the wide-ranging plan, which Gov. Ed Rendell is expected to approve, would establish collaborative groups around the state to help doctors learn ways to improve chronic care, focusing first on diabetes in adults and asthma in children.

Insurers would play a key role, providing financial incentives for doctors to try the approach and for patients to better manage their own health.

Experts characterized the plan, developed by state officials, health insurers and representatives of hospitals, unions, foundations and other groups, as a bold attempt to try to reverse the growing toll taken by chronic diseases on patients and the system.

"I think it's really groundbreaking," said Dr. Edward Wagner, who provided input for the plan and helped to develop the model for improving chronic care that Pennsylvania intends to use.

While his model has been used in other states, Pennsylvania's plan appears to be the most comprehensive, said Dr. Wagner, director of the MacColl Institute for Healthcare Innovation in Seattle.

Commission members want to see better coordinated care, less waste, better outcomes and reduced cost growth, and the Wagner model has shown evidence of meeting those goals, said Diane Holder, president of UPMC Health Plan who co-chairs the commission.

Insurers have shown willingness to invest in a new approach, said Dr. Donald Fischer, a commission member and chief medical officer for Highmark.

The commission's efforts are part of Prescription for Pennsylvania, an effort by the governor to cut health care costs, improve quality and expand access to care.

The prevalence of diabetes and other chronic illnesses is growing, the commission report notes, fueled in part by an increase in obesity and an aging population.

When he announced the chronic care commission last year, the governor said about 78 percent of the state's health care costs can be traced to about 20 percent of patients with chronic diseases.

Many experts have expressed concerns that the current health care system, which focuses on acute care, is not optimally organized to care for people with chronic diseases. Payment systems do not provide incentives for health professionals to spend time with patients to help manage chronic conditions.

The Wagner model aims to do better through a team approach, helping patients set goals to improve their overall health and using computers to track patients, their medical tests and other needs.

The report calls for collaborative groups to help medical practices learn how to implement the model and for insurers to develop incentives to encourage doctors to participate.

About 50 doctors or advanced practice nurses and their colleagues would participate in each collaborative. They would meet two to four times a year to train, share experiences, review data and engage in problem solving.

The first collaborative would be launched in Philadelphia this spring, with others held later around the state.

"There are things we're going to learn along the way," said Dr. Linda Siminerio, who co-chairs the commission's performance measurement committee. Different interventions will be tested as the process moves forward, said Dr. Siminerio, executive director of the University of Pittsburgh Diabetes Institute.

Financial incentives to medical practices could include upfront payments to help them redesign their systems, enhanced capitation or fee-for-service payments to help maintain additional staffing, and performance bonuses for those that demonstrate superior clinical care.

For consumers, incentives could include waiving co-pays or reducing health care premiums, said Albert Black, chief operating officer of the Hospital of the University of Pennsylvania.

Mr. Black, a co-chairman of the commission's consumer engagement committee, said another possibility includes using pharmacists or other coaches to help patients learn ways to better manage their chronic illness. Positive results from similar collaborations have been noted by the Asheville Project in North Carolina. Some Pittsburgh companies have participated in a related effort, the Diabetes Ten City Challenge.

Eventually, the state wants to use pooled claims data from insurers to assess progress, said Ann Torregrossa, deputy director of the state Office of Health Care Reform.

In their report, commission members recommend discontinuing the chronic care initiative if evaluations fail to show improved quality of care and a decrease in the rate of health care cost growth in three years.

But they predicted otherwise, noting that similar efforts have been successful in other states and in the Veterans Affairs health care system.