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Chronic disease management: Does it improve
health and save money?
INDIANAPOLIS –A study published in the
May/June issue of Health Affairs reports on
the first randomized trial providing a
scientifically valid look at what one might
expect from chronic disease management
programs that serve low-income individuals.
The study result provides good news for
state Medicaid leaders struggling to meet
the needs of individuals with chronic
conditions and also suggests that some
disease management efforts, even among
relatively low-risk patients, may be an
effective strategy.
While chronic disease management programs,
also known as chronic care management, have
become widespread across the United States,
gaining favor with employer groups,
health-care organizations and health payers,
these programs are being increasingly
questioned because very little scientific
evidence exists regarding their
effectiveness and fiscal impact.
Researchers from the Indiana University
School of Medicine, the Regenstrief
Institute, and the School of Public and
Environmental Affairs at Indiana
University–Purdue University Indianapolis
designed a study to determine whether
chronic disease management of individuals
with diabetes and/or congestive heart
failure (CHF) improves health outcome and
lowers healthcare costs.
In contrast to earlier studies, the
researchers randomly assigned individuals
with the two chronic conditions to either
chronic disease management or a control
group based on their primary care provider’s
location.
The researchers used a predictive model to
identify individuals at risk for high levels
of future health-care utilization.
Individuals judged to be at highest risk
were given intensive health care management
conducted by a nurse care manager.
Those with lower risk were provided with
education and care support over the phone.
Their findings were much more complex than
they had anticipated.
“The telephonic support, when given to the
lower risk group for either disease,
resulted in a significant reduction in
subsequent health-care claims paid,” said
study senior author Thomas S. Inui, M.D., IU
School of Medicine associate dean for health
care research and Sam Regenstrief Professor
of Health Services Research. Dr. Inui also
is president and CEO of the Regenstrief
Institute.
Results for high-risk patients were more
ambiguous. The researchers found that nurse
care management resulted in lower average
claims for high-risk CHF patients, but
slightly higher average claims for high-risk
diabetes patients, although neither effect
was found to be statistically significant.
One of the strengths of this evaluation is
that the fiscal impact analysis included the
costs of delivering the chronic disease
management intervention, not just the impact
on claims for subsequent utilization.
“Once we considered these additional costs,
we discovered the net fiscal impact of
chronic disease management was positive only
for low-risk CHF patients,” said lead author
Ann M. Holmes, Ph.D., associate professor,
IUPUI School of Public and Environmental
Affairs.
The 23 month study was too short to
determine clinical outcomes for either
disease.
Future work is needed to determine whether
long run chronic care management improves
control and outcomes in diabetes or improves
heart function in those with CHF.
“This is a study with real health policy
impact. Our findings were so encouraging
that Indiana Medicaid, which funded our
work, enrolled its Aging, Blind and Disabled
program eligible patients in care management
plans,” said Dr. Inui.
###
In addition to Dr. Holmes and Dr. Inui
co-authors of the study are Ronald
Ackermann, M.D., Barry P. Katz, Ph.D. and
Stephen M. Downs, M.D., all of the IU School
of Medicine and the Regenstrief Institute,
and Alan J. Zillich, Pharm.D. of the Purdue
School of Pharmacy and the Richard Roudebush
VA Medical Center.
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