Congress is lukewarm about the ability of disease management to curb Medicare costs.
isease
management programs, ranging from telephone reminders to quit smoking to home
visits to assist high-risk pregnant women, have been touted as a home run for
public health and corporate bean counters alike.
And new programs like Blue Cross and Blue Shield of North
Carolina’s obesity initiative continue to be launched. In 2003, 58 percent of
employers provided at least one such program, compared with 41 percent in 2002,
according to a survey on employer-sponsored health plans conducted by Mercer
Human Resource Consulting.
Still, the cost-savings question remains unanswered at
best.
In October, the Congressional Budget Office was lukewarm
about the ability of disease management to curb Medicare’s rising costs. Studies
so far have primarily focused on medical outcomes, such as blood sugar readings
in diabetics, the report’s authors wrote. When the numbers were crunched, not
all of the relevant medical costs were included.
A study of Texas patients, reported at the American Heart
Association’s annual meeting in November, found that a congestive heart failure
education program extended patient survival by two months, but didn’t save any
money.
"It made people feel better. But it did not keep them out
of the hospital or the doctor’s office." says Dr. Autumn Dawn Galbreath, study
author and director of the disease management center at the University of Texas
Health Sciences Center in San Antonio
Galbreath is quick to acknowledge that her research,
as well as the Congressional Budget Office analysis, involves older and
generally sicker patients rather than the typical employee. Even so, she says,
"people just need to be realistic in their anticipation of savings."
One problem is that disease management encompasses such a
grab bag of programs that it’s difficult to draw any broad conclusions, says
Kenneth Thorpe, chairman of the department of health policy and management at
Emory University’s Rollins School of Public Health in Atlanta.
Rather than debunking the overall concept, energy should
be focused on finding the most effective approach, Thorpe says. He recently
completed a study showing that 27 percent of the nation’s ballooning health
costs from 1987 to 2001 could be attributed to obesity.
Referring to the increasing pounds Americans are gaining,
Thorpe says, "Right from the get-go, your workers are sicker than they were 20
years ago. If you are going to manage these chronic (health) conditions, you
have to manage people’s behavior."
Cigna HealthCare’s efforts with diabetes patients are an
example of a success story. Research published over the summer in the journal
Health Affairs tracked the results of more than 43,000 members enrolled in
the company’s diabetes disease management program from 1998 to 2001. When
participants remained active in the program most of the first year, their
average medical costs declined 8.1 percent from the previous year.
Even transient interest in the program appeared to have a
demonstrable impact. Medical costs for all participants, including those
involved just a month or two, declined 5.3 percent.
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