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

Disclosures

Diabetes Care. 2002;25(4) 

In This Article

Results

There were 6,799 continuously enrolled patients who fulfilled diabetes HEDIS criteria during the 2 years of this study. A total of 3,118 (45.9%) subjects had enrolled in disease management and were managed by 51 disease management nurses, as compared with 3,681 (54.1%) subjects who were not in disease management. The average number of visits with an HMO nurse was 3.63. A total of 419 (13.43%) patients visited a nurse one time, and 2,699 (86.57%) visited a nurse two or more times. Table 1 compares the male-to-female ratio, age, HMO enrollment duration, presence of a pharmacy benefit plan, and insurance type (commercial versus Medicare risk) between the study subjects fulfilling HEDIS criteria who were in disease management (program) and those fulfilling HEDIS criteria who were not in disease management (nonprogram). Of the demographic variables, sex was not significantly different between the two groups (P > 0.05), but program patients were on average 1.4 years younger (P < 0.05), had longer enrollment duration in the HMO, were more likely to have a pharmacy benefit plan, and were more likely to have commercial insurance (P < 0.05 for all four measures).

During the 2-year period of study, program patients experienced $394.62 per member per month in mean total paid claims, as compared with $502.48 for those not in disease management (P < 0.05, Student’s t test). This difference was accompanied by lower inpatient use among program patients, who experienced a mean of 0.12 admissions per patient per year and 0.56 inpatient days per patient per year, as compared with nonprogram patients, who had 0.16 admissions and 0.98 inpatient days per patient per year (P < 0.05 for both measures.). The mean number of emergency room visits was 0.49 per patient for program patients compared with 0.56 among nonprogram patients (P < 0.05). In contrast to emergency room use, program patients experienced a higher mean number of primary care office visits (8.4) per patient per year compared with nonprogram patients (7.8). When these data were compared while statistically controlling for age, sex, enrollment duration, presence of a pharmacy benefit, and insurance type, all measures of use, except for emergency room visits, remained statistically significant ( Table 1 ). When enrollees in commercial and Medicare risk insurance lines were compared separately, statistically significant lower mean paid claims per member per month among the program patients, as compared with nonprogram patients, persisted ($302.19 vs. $527.96 and $424.00 vs. $500.37, respectively, P < 0.05 for all measures).

Program patients also experienced favorable HEDIS scores compared with nonprogram patients. HbA1c testing as well as lipid, eye, and kidney screening were 96.6, 91.1, 79.1, and 68.5%, respectively, among program patients compared with 83.8, 77.6, 64.9, and 39.3%, respectively, among nonprogram patients. All observed differences were statistically significant (P < 0.05). A total of 1,074 patient charts (526 program and 548 nonprogram patients) were reviewed for determination of HbA1c under control. Thirty-five (6.7%) program patients had HbA1c >9.5% compared with 79 (14.4%) nonprogram patients ( Table 1 ).

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