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: 2.26). 01/2008; 13(12):670-6.
Source: PubMed


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.

Download full-text


Available from: Michael Seid
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: For over two decades, disease management (DM) has been touted as an intervention capable of producing large scale cost savings for health care purchasers. However, the preponderance of scientific evidence suggests that these programs do not save money. This finding is not surprising given that the theorized causal mechanism by which the intervention supposedly influences the outcome has not been systematically assessed. Mediation analysis is a statistical approach to identifying causal pathways by testing the relationships between the treatment, the outcome, and an intermediate variable that is posited to mediate the relationship between the treatment and outcome. This analysis can therefore help identify how to make DM interventions effective by determining the causal mechanisms between intervention components and the desired outcome. DM interventions can then be optimized by eliminating those activities that are ineffective or even counter-productive. In this article we seek to promote the application of mediation analysis to DM program evaluation by describing the two principal frameworks generally followed in causal mediation analysis; structural equation modeling and potential outcomes. After comparing several approaches within these frameworks using real and simulated data, we find that some methods perform better than others under the conditions imposed upon the models. We conclude that mediation analysis can assist DM programs in developing and testing the causal pathways that enable interventions to be effective in achieving desired outcomes.
    Full-text · Article · Dec 2013 · Health Services and Outcomes Research Methodology
  • Source
    • "During the last decade, the United States has witnessed the accelerated inflation of health care costs and a growing burden of chronic disease including obesity. In 2012, the Centers for Medicare and Medicaid Services projected that health spending will account for 19.6% of the gross domestic product (GDP) in 2021, up from 17.9% in 2010.1 While existing conventional interventions, including disease and case management services, in some instances have improved clinical processes of care, they have not led to significant or sustainable changes in the health-related behaviors that are critical for increasing the health status of Americans and decreasing the cost of healthcare.2 For over a decade, health risk assessments have been in common use but have been inadequately effective in identifying or fostering the self-management strategies necessary for achievement of sustainable improved health behaviors that impact both current health status and future risks. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Health coaching is a client-centric process to increase motivation and self-efficacy that supports sustainable lifestyle behavior changes and active management of health conditions. This study describes an intervention offered as a benefit to health plan members and examines health and behavioral outcomes of participants. High-risk health plan enrollees were invited to participate in a telephonic health coaching intervention addressing the whole person and focusing on motivating health behavior changes. Outcomes of self-reported lifestyle behaviors, perceived health, stress levels, quality of life, readiness to make changes, and patient activation levels were reported at baseline and upon program completion. Retrospectively, these data were extracted from administrative and health coaching records of participants during the first 2 full years of the program. Less than 7% of the 114 615 potential candidates self-selected to actively participate in health coaching, those with the highest chronic disease load being the most likely to participate. Of 6940 active participants, 1082 fully completed health inventories, with 570 completing Patient Activation Measure (PAM). The conditions most often represented in the active participants were depression, congestive heart failure, diabetes, hyperlipidemia, hypertension, osteoporosis, asthma, and low back pain. In 6 months or less, 89% of participants met at least one goal. Significant improvements occurred in stress levels, healthy eating, exercise levels, and physical and emotional health, as well as in readiness to make change and PAM scores. The types of client-selected goals most often met were physical activity, eating habits, stress management, emotional health, sleep, and pain management, resulting in improved overall quality of life regardless of condition. Positive shifts in activation levels and readiness to change suggest that health coaching is an intervention deserving of future prospective research studies to assess the utilization, efficacy, and potential cost-effectiveness of health coaching programs for a range of populations.
    Full-text · Article · May 2013
  • Source
    • "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) "
    [Show abstract] [Hide abstract]
    ABSTRACT: This presentation describes several different types of value that may arise from corporate health and productivity management programs. It also offers a dose of reality regarding expectations for the return on investment in these programs.
    Full-text · Conference Paper · Apr 2013
Show more