Chronic disease management: Does it improve health and save money?

“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.