Does Diabetes Disease Management Save Money and Improve Outcomes?

Abstract

OBJECTIVE -Little is known about the impact of disease management programs on medical costs for patients with diabetes. This study compared health care costs for patients who fulfilled health employer data and information set (HEDIS) criteria for diabetes and were in a health maintenance organization (HMO)-sponsored disease management program with costs for those not in disease management.RESEARCH DESIGN AND METHODS -We retrospectively examined paid health care claims and other measures of health care use over 2 years among 6,799 continuously enrolled Geisinger Health Plan patients who fulfilled HEDIS criteria for diabetes. Two groups were compared: those who were enrolled in an opt-in disease management program and those who were not enrolled. We also compared HEDIS data on HbA 1c testing, percent not in control, lipid testing, diabetic eye screening, and kidney disease screening. All HEDIS measures were based on a hybrid method of claims and chart audits, except for percent not in control, which was based on chart audits only.RESULTS -Of 6,799 patients fulfilling HEDIS criteria for the diagnosis of diabetes, 3,118 (45.9%) patients were enrolled in a disease management program (program), and 3,681 (54.1%) were not enrolled (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged $394.62 for program patients compared with $502.48 for nonprogram patients (P Ͻ 0.05). This difference was accompanied by lower inpatient health care use in program patients (mean of 0.12 admissions per patient per year and 0.56 inpatient days per patient per year) than in nonprogram patients (0.16 and 0.98, P Ͻ 0.05 for both measures). Program patients experienced fewer emergency room visits (0.49 per member per year) than nonprogram patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, P Ͻ 0.05 for both measures). Except for emergency room visits, these differences remained statistically significant after controlling for age, sex, HMO enrollment duration, presence of a pharmacy benefit, and insurance type. Program patients also achieved higher HEDIS scores for HbA 1c testing as well as for lipid, eye, and kidney screenings (96.6, 91.1, 79.1, and 68.5% among program patients versus 83.8, 77.6, 64.9, and 39.3% among nonprogram patients, P Ͻ 0.05 for all measures). Among 1,074 patients with HbA 1c levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level Ͼ9.5%, as compared with 79 of 548 (14.4%) nonprogram patients.CONCLUSIONS -In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical co...

Using Clinical Information To Project Federal Health Care Spending

“…We assumed that annual program costs for each enrolled patient would be $424, based on an estimate of costs from prior studies of diabetes quality improvement programs. 23,24 Additionally, with the program in place, the cost of diabetes care related to preventive medications and routine testing would increase by $600 per patient annually based on a micro-costing exercise, 25 thereby bringing the to- tal annual cost per patient to $1,024. Based on the peer-reviewed literature, we assumed that the intervention would lead to multiple improvements in diabetes care.…”

Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes

“…The impact of lowering A1c on medical costs is mixed. [36][37][38][39][40][41] The recently reported outcomes of the Medicare Health Support Disease Management Pilot Program, which enrolled more than 100,000 individuals with diabetes in the intervention and approximately 60,000 in the control group, showed no evident reduction in the utilization of acute care or the cost of care. 42 DSME is typically performed by diabetes educators and is a covered benefit by Medicare and many commercial payers.…”

A Focused Telephonic Nursing Intervention Delivers Improved Adherence to A1c Testing

“…In fact, diabetes is the most frequently included condition among DM program offerings. While numerous studies have demonstrated the ability of DM to decrease A1c levels, 3,10 there are few analyses of the impact of DM on the frequency of A1c testing in a large population.…”

“…[2][3][4][5] The Diabetes Control and Complications Trial (DCCT) found that persons receiving intensive insulin treatment to reach a glycemic goal of 6.05% or less had dramatic relative reductions in risk for microvascular and neurological end points, including greater than 70% reduction for clinically important sustained retinopathy, 56% for laser photocoagulation, 39% for microalbuminuria, and 60% for confirmed clinical neuropathy. Although they did not reach statistical significance, specific macrovascular end points realized an approximate 41% risk reduction for combined macrovascular events.…”