Does Diabetes Disease Management Save Money and Improve Outcomes?

Does Diabetes Disease Management Save Money and Improve Outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization–sponsored disease management program among patients fulfilling health employer data and information set criteria Jaan Sidorov , MD, FACP, CMCE 1 , Robert Shull , PHD 1 , Janet Tomcavage , RN, MSN, CDE 1 , Sabrina Girolami , RN, BSN 1 , Nadine Lawton , RN 2 and Ronald Harris , MD, FACE 1 1 Care Coordination Program, Geisinger Health Plan, Danville, Pennsylvania 2 Quality Improvement Program, Geisinger Health Plan, Danville, Pennsylvania Abstract 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 HbA 1c 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