Disease Management – Not yet the answer to reducing health care costs
Health care reform plans are now being unveiled every day. They are arising from the new administration, Congress and every health care and consumer advocacy group in the country. The Congressional budget office has provided law makers with a comprehensive analysis of the impact of 115 different options that are found in these plans. Almost all of these proposed plans suggest that poor quality and inefficiency be eliminated.
One cost issue that appears amenable to intervention is the management of patients with chronic disease. It is well known that a small number of patients with chronic disease generate a disproportionate amount of costs in the health care system. It is also true that many of these patients do not receive timely, coordinated, evidence-based care. Therefore a number of organizations have arisen that provide the new service of “disease management.”
The most recent edition of Health Care Financing Review reports on the results of a number of major demonstration projects conducted by CMS to test the efficacy of disease management for Medicare beneficiaries. In one study, eight disease management firms were engaged to provide their services to randomly selected Medicare patients. Although the study is ongoing, CMS found that “results to date indicate limited success in achieving Medicare costs savings or reducing acute care utilization.”
A group of patients eligible for both Medicare and Medicaid was also studied, with a focus on patients with diabetes, congestive heart failure and coronary heart disease. Once again the results were disappointing: “Findings . . . show virtually no overall impact on hospital or emergency room use, quality of care, or prescription drug use.”
A key feature of these demonstrations was that each of the disease management firms were not directly connected to providers. Support and management was provided with nurses via the phone and the mail.
By contrast, a much more encouraging potential model for disease management is integrated into the actual care system. The New York Times recently identified the Marshfield Clinic as one of the leaders in effectively using information technology to support disease management and embed it into the daily care patterns of the clinic. Marshfield’s results translate into an annual cost saving of $7.3 million to $20.5 million for its diabetic patients.
Disease management is still a promising concept but its application may only be effective in those health care organizations that have the structure and focus to apply all the tools of contemporary health care operations management.
References:
1. Cromwell, Jerry, et. al. "Evaluation of Medicare Health Support Chronic Disease Pilot Program." Health Care Financing Review, Fall2008, Vol. 30 Issue 1, p47-60.
2. Esposito, Dominick, et. al. "Impacts of a Disease Management Program for Dually Eligible Beneficiaries." Health Care Financing Review, Fall2008, Vol. 30 Issue 1, p27-45.
3. Lohr, Steve. "Health Care That Puts a Computer on the Team." New York Times, December 26, 2008.
