Disease Management Lessons from Germany

Chronic disease is responsible for a high percentage of health spending.   Many efforts are under way to both prevent people from acquiring chronic diseases; from moving to higher levels of severity and from incurring multiple hospitalizations and ER visits, which tend to drive spending.  Countries other than the US have focused on this issue and lessons can be learned from their experience, even though their health care delivery and insuring mechanisms are often different from ours.  An article in Health Affairs describes a German disease management program and reviews its results.  (HA Article)

Diabetes accounts for about 14% of Germany’s total spending on health and diabetes patients cost four times more than average.  Germany’s health care is largely paid for by sickness funds and those funds have worked with the government and providers to create a disease management program operated through primary care physicians.  Enrollment is voluntary for patients and physicians, but incentives are given for participating.  Care is driven by guidelines and physicians get feedback on their performance.  The patient’s primary care physician is responsible for educating the patient on the disease and treatment and for setting objectives for control of diabetes.

The researchers compared patients in the disease management program with those who were not enrolled.  The intervention group showed less mortality and fewer complications.   Overall drug and hospital costs were lower as well as the number of hospitalizations and their duration.  Drug costs alone were slightly higher, which is consistent with other research showing that disease management programs tend to enhance medication use and adherence.  Even after the cost of the program, there was about  $209 a year lower spending on the program enrollees.  Patient satisfaction was also higher.

Particularly if the medical home or accountable care organization concepts gain real traction, physicians in the United States are likely to be more responsible for care and disease management efforts in regard to their patients.  The German experience shows the potential benefits of this provider-oriented approach to disease management.