Which conditions show reduced costs with disease management?

Eric Jutkowitz, BA, and colleagues evaluated the cost impact of a DM program for University of Minnesota employees and dependents. Disease management programs use various approaches to improve management of common, high-cost chronic diseases.

Over a six-year period, the DM program led to significant cost reductions for most targeted conditions. Health care spending was decreased for patients with asthma, cardiovascular disease, congestive heart failure, depression, musculoskeletal disorders, low back pain, and migraine headaches.

The DM approach reduced hospitalizations for these same conditions, except congestive heart failure. It specially reduced "avoidable" hospitalizations for asthma, depression, and low back pain.

The DM program did not reduce costs for patients with diabetes, arthritis, or osteoporosis. There was no effect on work absences for any of the targeted conditions.

Employers are interested in DM approaches to help control the high health and productivity costs of chronic diseases. However, because of differences between programs, it is difficult to evaluate their effectiveness for different conditions. The University of Minnesota DM program relies largely on disease-specific telephone coaching.

The new study suggests that this DM approach can reduce costs and hospitalization rates for patients with several common and costly conditions, but not others -- notably including diabetes. The researchers note that studies of other DM programs have reported reductions in diabetes costs.

"Employers should focus on those conditions that generate savings when purchasing DM programs," Jutkowitz and colleagues write. They believe their DM approach succeeded in lowering costs in part by reducing "management breakdowns" that lead to avoidable hospitalizations.