The Value of Care Management

A recent article in The American Journal of Managed Care (volume 15, page 295, May 2009), described findings from a comparison within the Kaiser Permanente system of patients with diabetes who were subject to a care management program and those who were not.  Kaiser’s diabetes care management program used nurses to provide intensive counseling on medication, diet and other measures to keep the patients’ diabetes and associated conditions under control.  The patients were referred to the program by primary care physicians and were treated for a view months with the goal of improving their risk factors while they were in the program and making them better self-managers of their care.

The study looked at a controlled comparison of patients who were referred to the program and those who were not.  Primary measures were medication adherence, glycemic control, blood pressure and lipid levels.    The study did not assess ultimate outcomes such as hospitalizations, heart attacks, etc., nor did it look at comparative costs for the two groups.  The patients in the care management group showed a statistically significant, but quite modest, difference in improvement over the control group.

Most interestingly was that both groups showed excellent improvement in the measures, with the control group patients doing almost as well as the intensively managed group.  This may have due to other quality initiatives being conducted within Kaiser at the time or to greater physician awareness of the importance of these measures in treating patients with diabetes effectively.  One suspects that if the cost of the program is taken into account, it might not have been financially justified, but it is difficult to know without some actual care cost comparisons.  It does suggest that there may be multiple methods outside intensive management programs to see improvements in patients’ care and health.