Diabetes America has released a white paper regarding a disease management program performed for Aetna members. The analysis covered 30 months. The program offered a number of diabetes-specific health care services and followed participants carefully. (DA Paper) The participants were offered incentives and the cost of those does not appear to be added into the cost analysis, nor does the cost of the program. The analysis did look at per member per month medical costs and at clinical outcomes such as HBA1c, certain diabetes patient exams and LDL. The analysis involved comparing participants in the program with a matched group that did not participate.
In the first year of the program, participants did not show a significant difference in all condition medical spending, but did show an increase in diabetes-specific medical costs and all-condition pharmacy costs compared to the control group. While the number of patients in the program who had their diabetes under control increased, so did those in the control group. In the second year there was also no significant difference in medical spending, but diabetes-specific costs and pharmacy spending were higher and the number of participants with their diabetes in control decreased significantly, while it actually increased slightly in the control group. For the last six months of the program, the first half of 2009, medical costs were $186 per member per month lower for participants than for control patients, primarily due to lower hospital and emergency room use. That is after accounting for the higher diabetes-specific spending. The participants also showed lower spending on common diabetes comorbidities.
The program’s results suggest that medical cost savings of $2200 a patient per year are possible when good diabetes care management occurs. There are a lot of people with diabetes in this country. For a thousand patients, that is over $2 million dollars and for a million, $2.2 billion. The real lesson, however, is that disease and care management programs take time to show savings and may even have some interim cost increases. People whose care hasn’t been carefully managed usually need more exams, tests and drugs at first. But over a relatively short time, two and a half years for this program, significant savings begin to be seen. Those savings might be expected to increase as the years go on and the patients stay in better health. Disease management companies did themselves no favors by promising immediate large savings. And some payers, like Medicare, have created unreasonable expectation of fast returns on care management efforts. Given time, it is likely that most disease management efforts will produce cost reductions that far outweigh the costs of the programs and more importantly, the patients’ health and quality of life is being dramatically improved.