Disease management programs for chronically ill address cost

Healthcare Financial Management, Jan, 2004

Health plan enrollees in disease management (DM) programs had fewer hospital admissions and fewer emergency department visits, as well as lower overall costs, according to a November 6 report released by the American Association of Health Plans and the Health Insurance Association of America (AAHP-HIAA).

AAHP-HIAA sponsored a survey of 25 different DM programs for conditions such as congestive heart failure, coronary artery disease, congestive obstructive pulmonary disease, end-stage renal disease, diabetes, and low back pain. The plans' DM programs include Medicare and Medicaid beneficiaries, enrollees in commercial HMOs and PPOs, and members of self-funded employer plans.

For example, the study looked at an evaluation of a health plan with a multicondition DM program for its Medicare, Medicaid, and commercial members. The results disclosed that for every dollar spent, the health plan saved $2.94. Preliminary analysis of the program also found a net savings of $0.90 per member, per month. A similar program that another health plan established for commercial HMO and employer or self-insured members found that the program saved between $2.25 and $2.50 for every dollar spent.

For more information, go to www.aahp.org and click on the following succession of links: "AAHP Website," "About AAHP," "News Room," "Press Releases." Then select the press release dated 11/6/2003.