An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative: Economic and Selected Clinical Outcomes
Abstract
Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-sponsored case management and disease management programs for actively enrolled participants were compared during the fiscal year January 1, 1998 to November 31, 2000. Interventions: The disease management programs addressed asthma, diabetes mellitus and congestive heart failure (CHF). These programs were based on a network of primary care-based nurse educators and case managers promoting clinical guidelines, appropriate use of the insurance benefit, community-based resources, and communication among all healthcare providers. Setting and participants: This initiative was based in 55 primary care sites serving 295 000 insureds across northeastern and central Pennsylvania, USA. Results: 396 patients with asthma had mean baseline PMPM charges of $US298, which decreased to $US276 PMPM after entry. In those with diabetes mellitus, 3556 patients had a mean baseline PMPM charge of $US367 that decreased to $US346. The mean baseline PMPM charge decreased from $US1877 to $US1541 for 1795 patients with CHF. For 3346 patients undergoing case management, the mean baseline PMPM charge was $US1991 and it decreased to $US1545. Total mean reductions in claims over one year of follow-up from the day of entry for patients with asthma, diabetes mellitus, CHF and for case management programs were $US105 544, $US896 112, $US7 237 440 and $US17 907 992, respectively. Additional data regarding asthma-only claims and pre-post days of work loss in the previous six months, diabetes mellitus-only claims and pre-post mean glycosylated hemoglobin A1c values, inpatient and outpatient CHF total claims, ACE inhibitor use in CHF, and inpatient and outpatient total claims in case management are also provided. Conclusion: While these claims data may be limited by a lack of statistical significance and by regression to the mean, they suggest that case management and disease management programs in asthma, diabetes and congestive heart failure can be associated with significant financial savings compared with baseline levels of utilization. Clinical outcomes data also suggest this approach may be of benefit.Download Info
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Bibliographic Info
Article provided by Wolters Kluwer Health | Adis in its journal Disease Management & Health Outcomes.
Volume (Year): 10 (2002)
Issue (Month): 1 ()
Pages: 9-16
Download reference. The following formats are available: HTML
(with abstract),
plain text
(with abstract),
BibTeX,
RIS (EndNote, RefMan, ProCite),
ReDIF
Handle: RePEc:wkh:dmhout:v:10:y:2002:i:1:p:9-16
Contact details of provider:
Web page: http://diseasemanagement.adisonline.com/
For corrections or technical questions regarding this item, or to correct its listing, contact: (Dave Dustin).
Related research
Keywords: Asthma; Congestive heart failure; Cost analysis; Diabetes mellitus; Disease management programmes; Pharmacoeconomics;Find related papers by JEL classification:
- C - Mathematical and Quantitative Methods
- D - Microeconomics
- I - Health, Education, and Welfare
- Z - Other Special Topics
- I1 - Health, Education, and Welfare - - Health
- I19 - Health, Education, and Welfare - - Health - - - Other
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
References
No references listed on IDEASYou can help add them by filling out this form.
Citations
Lists
This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.Statistics
Access and download statisticsCorrections
When requesting a correction, please mention this item's handle: RePEc:wkh:dmhout:v:10:y:2002:i:1:p:9-16For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dave Dustin).
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.