Disease Management Programs Don’t Work

That is the conclusion of this study. More information below:

Background

The ARRA stimulus package included $2.2 billion for health care cost-effectiveness research focusing on chronic disease prevention and disease management initiatives. These programs aim to address increasing health care costs for a number of diseases, such as: cancer, diabetes, heart disease, obesity, and smoking-related illnesses. The disease management initiatives hope to improve health outcomes and reduce the costs that occur due to acute aggravations or worsening symptoms by aligning patient care with the evidence base.

State Implementation and Identification Strategy

Washington, Texas, and Georgia have implemented diabetic disease management programs. The authors use a difference in difference strategy to measure whether costs and number of emergency admissions for Washington, Texas, and Georgia decreased relative to states that did not implement diabetic disease management programs. Washington implemented its disease managment program in 2002, Texas in 2004, and Georgia in 2005. The authors use the National InPatient Sample (NIS) data from the Health Care Cost and Utilization Project (HCUP) between the years 2000-2008.

Results

The authors found no effect. The following three graphs display this results graphically.

Additional regression analysis finds that reform did not create statistically significant decreases in either in emergency admissions or inpatient charges.  The regression models controlled for state and year effects with dummy variables as well as median state income, state obesity rate, and state Medicaid enrollment to isolate the effects of the disease management programs on the two outcome variables.

Thus, the authors conclude that “This study finds that the disease management programs enacted in Washington, Texas, and Georgia were not effective at controlling inpatient diabetic costs or reducing emergency department admissions.”

Source

• Conti, M. S. (2012), Effect of Medicaid Disease Management Programs on Emergency Admissions and Inpatient Costs. Health Services Research. doi: 10.1111/1475-6773.12024