Cost Savings for a Preferred Provider Organization Population with Multi-Condition Disease Management: Evaluating Program Impact Using Predictive Modeling with a Control Group

Abstract

Disease management programs have historically had difficulty demonstrating the financial value of their programs using statistically rigorous methods. This preliminary study utilized a predictive model built from a control group that consisted of individual employer groups whose benefits managers did not purchase disease management. The purpose of this evaluation was to examine the cost savings associated with Health Management Corporation's disease management program for asthma, diabetes, and coronary artery disease. Study and control group members were identified with exactly the same selection criteria as self-insured employer groups (n = 76,194) with preferred provider organization health plans that offered the disease management program. The study group consisted of members (n = 1,009) who were identified as having any of the three conditions and were eligible for the disease management program, regardless of the extent of their participation. The control group included members (n = 2,491) who were identified as having any of the same three conditions. The control group data were used to develop a predictive model designed to calculate expected medical claims costs for the study group. The gross savings of the disease management program was measured by calculating the difference between the expected medical claims costs predicted by the model and the actual medical claims costs for the study group. Preliminary analyses indicate that Health Management Corporation's disease management program produced a return on investment of $2.84: $1.00 and $1.45 gross savings per member per month.

Worksite Health Promotion: The Value of the Tune Up Your Heart Program

“…29 For example, individuals with the highest claims costs before the intervention are not likely to incur the highest claims costs after the intervention, even in the absence of lifestyle modification. 30 Regression to the mean particularly affects extreme measures; however, in this study improvements in all of the measured components of risk were significant. Furthermore, the proportion of high-risk patients with extreme measures was relatively low.…”

Implementation and Outcomes of Commercial Disease Management Programs in the United States: The Disease Management Outcomes Consolidation Survey

“…15,16 Of the five ROI values provided by survey respondents for diabetes and asthma programs, four indicated cost savings of similar magnitude to ROI for DM programs targeting these conditions reported in the recent literature, [17][18][19] but one suggested increased costs. Given the diversity of patient populations, program designs and analytical methods used by responding health plans, such variation in financial results is not unexpected.…”

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“…Cost information is reported as it appeared in the original articles to avoid an artificial presentation of results given changing patterns of care and the long time frames of data analysis (>10 years in some studies); however, as an aid for the reader, we used the medical component of the 16 This study, following patients the year before and after (1999)(2000) implementation of a DMP, used predictive modeling from medical and pharmacy claims for total costs and was not limited to disease-specific costs. This study may have failed to exclude diabetes patients from the CAD analysis, thus inflating the burden of CAD as a single diagnosis.…”