Does Diabetes Disease Management Save Money and Improve Outcomes?

Jaan Sidorov, MD, FACP, CMCE, Robert Shull, PHD, Janet Tomcavage, RN, MSN, CDE, Sabrina Girolami, RN, BSN, Ronald Harris, MD, FACE, Nadine Lawton, RN


Diabetes Care. 2002;25(4) 

In This Article

Abstract and Introduction

Objective. Little is known about the impact of disease management programs on medical costs for patients with diabetes. This 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 with costs for those not in disease management.
Research Design And Methods. We 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.
Results. Of 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 (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged $394.62 for program patients compared with $502.48 for nonprogram patients (P < 0.05). 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 nonprogram patients (0.16 and 0.98, P < 0.05 for both measures). Program patients experienced fewer emergency room visits (0.49 per member per year) than nonprogram patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, P < 0.05 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 nonprogram patients, P < 0.05 for all measures). 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%) nonprogram patients.
Conclusions. In this HMO, 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. 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 is associated with significant health care costs. It has been estimated to affect 16 million Americans, with $44 billion a year in direct medical and treatment costs. Although people with diabetes account for only 3.8% of the U.S. population, this disease accounts for 5.8% of all personal health care expenditures in the U.S. [1].
The cost of diabetes care for managed care organizations (MCOs) is also substantial. MCO enrollees with diabetes have higher rates of cardiovascular, eye, lower-extremity, and renal disease compared with those without diabetes [2–4]. Several studies have conclusively demonstrated that complications from diabetes can be reduced by aggressive glycemic control [5–10]. As a result, many MCOs have sponsored initiatives to improve glycemic control among their members in the belief that this will reduce the rate of diabetes complications and associated health care costs.
Improving health outcomes and lowering use and costs underlie the strategy of disease management. Disease management is defined as any multifaceted program devoted to the care of populations characterized by the presence of a chronic disease. Disease management programs are usually financed with a fixed percentage of the insurance premium. If complication rates are lowered, the lower use and associated savings can result in profit for the sponsoring organization. Characteristics of disease management programs typically include disease staging, promotion of clinical guidelines, patient education that promotes self-management, aggressive screening for complications, and early and appropriate specialty referral [11–17].
Little is known about the impact of disease management programs on health care costs, quality of care, and complication rates among patients with diabetes. Disease management programs for diabetes vary in scope and content, and a significant number are offered by independent companies under proprietary circumstances [17–19]. It is also unclear whether disease management can result in short-term savings because the consequences of poor glycemic control occur over many years [20–24].
In this study, we describe the short-term medical cost savings associated with a health maintenance organization (HMO)-sponsored disease management program by comparing the claims of enrollees who fulfilled health employer data and information set (HEDIS) criteria and were in disease management with those not in disease management.