Diabetes Disease Management in a Community-Based Setting

MANAGED CARE June 2002. ©MediMedia USA

Gregory D. Berg, PhD

Senior Research Scientist, McKesson Corp.

Sandeep Wadhwa, MD, MBA

Vice President, Population Care Management, McKesson Corp., and Clinical Assistant Professor of Medicine, University of Colorado Health Sciences Center

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ABSTRACT

Purpose. The medical cost of diabetes in the United States in 1997 was at least $98 billion. This study illustrates the behavioral change and medical-care utilization impact that occurs in a community-based setting of a diabetes disease-management program that is applied to program participants in a health insurance plan's health maintenance organization and preferred provider organization.

Design. A historical control comparison of diabetes-management participants.

Methodology. One hundred twenty-seven identified diabetes patients are followed from baseline through 1 year. Differences in behavior are compared at program intake and at a 6-month reassessment. Differences in medical-service utilization are compared in the baseline year and the year subsequent to program enrollment. Poisson multivariate-regression models are estimated for counts of inpatient, emergency department, physician evaluation and management, and facility visits, while also controlling for potential confounders.

Principal findings. Behaviors improved between program intake and the 6-month reassessment. From patient reports, the number of participants having a hemoglobin A_1c test increased by 44.9 percent (p<.001), and there was a 53.2-percent decrease in symptoms of hyperglycemia (p=.002). From medical claims after program enrollment, a drop occurred during the program year in every dimension of medical-service utilization. Regression results show that inpatient admissions decreased by 391 (p<.001) per 1,000 for each group, while controlling for age, length of membership, and the number of comorbid claims for congestive heart failure. In the analysis of costs that were pre- and post-enrollment, which included disease-management program costs, a 4.34:1 return on investment was calculated.

Conclusion. The diabetes program provides patients with comprehensive information and counseling relative to practicing self-management of diabetes through a number of integrated program components. This study strongly suggests that the implementation of such a program is associated with positive behavioral change and, thus, with substantial reduction in medical-service utilization. In addition, the intervention resulted in a net decrease in direct medical costs.