Issue 106 Item 11 Diabetes Disease Management Saves Money and Improves Outcomes

Do the results justify the cost? >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.

The study 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 HbA1c 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.

The results showed that of the 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 (non-program). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the non-program patients. Per member per month paid claims averaged $394.62 for program patients compared with $502.48 for non-program patients. 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 non-program patients. Program patients experienced fewer emergency room visits (0.49 per member per year) than non-program patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, 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 HbA1c 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 non-program patients. Among 1,074 patients with HbA1c levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level >9.5%, as compared with 79 of 548 (14.4%) non-program patients.

From the study it was concluded that 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. These retrospective data demonstrate that participants in a managed care-sponsored diabetes disease management program experienced lower overall paid insurance claims for health care compared with those not in disease management. This difference was not only statistically significant but substantial, amounting to $104.86 per member per month or $ 1,294.32 per year. 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 costs. Diabetes Care 25(4):684-689, 2002