The financial logic supporting the growth of what has become known as disease management is clear and easy to understand.
People who live with chronic health conditions account for a substantial share of all health care expenditures. Consequently, any program that specifically targets this subset of the population is viewed as a reasonable, methodically correct way to address rising costs.
And when those same disease management programs generally result in better care, better quality of life and higher patient satisfaction, is it any wonder that disease management is the fastest-growing area in health care?
Disease management programs are becoming increasingly popular. According to Mercer Human Resources Consulting, the percentage of employer-sponsored health care plans offering disease management programs increased from 41 percent in fiscal 2002 to 58 percent in 2003.
Still, a nagging question remains: Do disease management programs really help contain costs?
Before we can answer that, we first need to examine what disease management programs are and how they operate. The first charge of any disease management program is to identify the population it would serve. Historically, individuals with specific and costly chronic conditions — diabetes, asthma, congestive heart failure and end-stage renal disease — have been targeted.
Once the population has been identified, a multidisciplinary team of providers needs to be assembled. This team can include physicians, nurses, pharmacists, dieticians, respiratory therapists and psychologists, all of whom collaborate to help patients manage their conditions.
Quite often, health plans assign nurses to serve as case managers for the individuals enrolled in the program. These nurses coordinate the member’s care, help improve the member’s understanding of his or her disease and teach the member how to proactively manage it.
Nurses maintain contact with the member in a variety of ways.
* Phone calls and mailings
* Home environment assessments
* Medication management
* 24-hour call centers
* Appointment reminder systems
“A successful disease management program must be a partnership between patient and health care provider,” the Pennsylvania Health Care Cost Containment Council (PHC-4) said in an August 2002 report.
If a viable partnership can be established, there is ample evidence to show it will foster patient satisfaction. According to a 2004 report by Georgetown University, 94 percent of individuals enrolled in a diabetes management program expressed satisfaction with the program. By comparison, 75 percent of nonenrollees expressed satisfaction with the quality of diabetes care they received.
There is a growing body of evidence to show that disease management is helping contain costs. Here’s what the PHC-4 found at one Pennsylvania health plan in a survey of 6,799 members who had diabetes.
* Average monthly health care costs for those in a disease management program: $394.62
* Average monthly health care costs for those not in a disease management program: $502.48
* Average annual savings per member: $1,200
In July 2004, Cigna Corp. reported that its diabetes programs in 12 states averaged cost savings of 5 percent to 8 percent.
At UPMC Health Plan, members in disease management programs benefit through decreases in hospital admissions and emergency room visits. In the congestive heart failure program, hospital admissions per 1,000 members decreased by 51 percent from June 2001 to June 2004. During that same span, emergency room visits fell 54 percent. The result is an estimated $1 million saved on health care spending.
In October 2004, the Congressional Budget Office (CBO) concluded that, despite some reported successes, there was “insufficient evidence” to prove that disease management programs reduce overall health spending. The uncertainty of the long-term effects and the cost of implementing these programs were two factors leading to that conclusion.
However, that was not the CBO’s final word on the subject.
“Improving health outcomes and mitigating health care costs do not necessarily go hand in hand, and disease management programs may be a worthwhile investment even if they do not reduce overall health care spending,” the CBO concluded.
It’s a “worthwhile investment” that all employers would be wise to consider.
Ronald J. Vance is vice president of sales and marketing for UPMC Health Plan. The Health Plan, with 440,000 members, is part of the University Pittsburgh Medical Center’s integrated medical delivery system and is the only provider-led health plan in Western Pennsylvania. Reach Vance at (412) 454-7642 or [email protected].
