Evidence for the Effect of Disease Management: Is $1 Billion a Year a Good Investment?

RAND Health, 1200 S Hayes St, Arlington, VA 22202, USA.
The American journal of managed care (Impact Factor: 2.17). 01/2008; 13(12):670-6.
Source: PubMed

ABSTRACT To assess the evidence for the effect of disease management on quality of care, disease control, and cost, with a focus on population-based programs.
Literature review.
We conducted a literature search for and a structured review of studies on population-based disease management programs, as well as for reviews and meta-analyses of disease management interventions. We identified 3 evaluations of large-scale population-based programs, as well as 10 meta-analyses and 16 systematic reviews, covering 317 unique studies.
We found consistent evidence that disease management improves processes of care and disease control but no conclusive support for its effect on health outcomes. Overall, disease management does not seem to affect utilization except for a reduction in hospitalization rates among patients with congestive heart failure and an increase in outpatient care and prescription drug use among patients with depression. When the costs of the intervention were appropriately accounted for and subtracted from any savings, there was no conclusive evidence that disease management leads to a net reduction of direct medical costs.
Although disease management seems to improve quality of care, its effect on cost is uncertain. Most of the evidence to date addresses small-scale programs targeting high-risk individuals, while only 3 studies evaluate large population-based interventions, implying that little is known about their effect. Payers and policy makers should remain skeptical about vendor claims and should demand supporting evidence based on transparent and scientifically sound methods.

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Available from: Michael Seid, Aug 25, 2015
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    • "A broader Congressional Budget Office review of the DM literature concluded that ''there is insufficient evidence to conclude that DM programs can generally reduce the overall cost of health care services'' (Congressional Budget Office 2004). This report was followed by several additional systematic reviews that arrived at similar conclusions (Ofman et al. 2004; Goetzel et al. 2005; Mattke et al. 2007). Despite this evidence, payors in the private sector continue to purchase DM services and DM continues to be discussed as a viable approach to achieving cost savings (Matheson et al. 2006; Mays et al. 2007). "
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    • "Sources: Aldana 2001; CBO, 2004; Chapman, 2003, 2005; Goetzel et al., 2005 and 2007; Mattke et al. 2007; Ozminkowski et al, 2006; Lerner et al, 2013 Review the peerviewed literature Talk to vendors Build or adopt a valid forecasting model • Peer-reviewed literature indicates that ROI from health management programs ‒ Depends on condition and focus of the program ‒ Depends on which outcomes are considered (medical, quality of care, satisfaction, productivity) "
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    • "Developing an approach to managing patients with chronic illness that successfully reduces hospital admissions and costs has proven challenging. Commercial disease management (DM) programs remain the predominant model, even though large-scale randomized controlled trials show little evidence of their effectiveness [1] [2] [3] [4]. Perhaps the most obvious limitation is that as a third party they have limited ability to influence the healthcare delivery process [5]. "
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    ABSTRACT: Objectives: To examine the effect of a hospital-based disease management program in reducing monthly hospital admission rates among patients with multiple chronic illnesses. Design: Interrupted time series analysis. Setting: A public hospital system comprised of three campuses in suburban Melbourne, Australia. Participants: 2,341 patients with three or more chronic illnesses enrolled in a hospital-based disease management program upon discharge. Intervention: Prior to hospital discharge, an inpatient coordinator refers eligible patients to the disease management unit (DMU). A DMU care coordinator invites patients to enroll and immediately schedules a comprehensive hospital-based outpatient clinic visit. The clinic utilizes a patient-centered team approach including a physician trained in multi-specialty care, a pharmacist, and a DMU nurse. Additional clinic visits are scheduled as needed. Between clinic visits, patients receive continued intensive contact with the DMU team, home visits by a pharmacist if necessary and optional patient education classes. The DMU liaises with the patient’s general practitioner throughout the program until the patient is stable. Measurement: Admissions per 1,000 patients per month (PTPM), evaluated 50 months before and 50 months after enrollment in the DMU program. Results: During the 50 month period pre-intervention period, admissions trended significantly upward at a rate of 2.43 admissions PTPM (95% confidence interval = 1.47, 3.38). Admissions PTPM during the 50-month period after enrollment trended significantly downward at a rate of 3.54 admissions PTPM (95% confidence interval = -4.71, -2.37). Conclusion: A comprehensive hospital-based disease management program successfully reduced monthly admissions for complex chronically ill patients during the 50 months following enrollment in the program compared to the prior 50 months. Contrary to many recent disease management evaluations, these findings suggest that it is possible to design a program to effectively reduce admissions, the largest cost driver in a chronically ill population, but that a person-centered closed-loop system involving both inpatient and outpatient services is likely required.
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