title: Cost-effective management of type 2 diabetes: providing quality care in a cost-constrained environment.
abstract: John Deere Health Care provides health coverage to 20,000 diabetic members in 5 states. Medical costs for those members are approximately 3 times higher than costs for nondiabetic members. Last year, John Deere Health Care introduced an integrated diabetes disease management program that includes telephone and mail reminders (managed by a vendor) for asymptomatic diabetic individuals, case management (managed by the plan) for diabetic members with complications or risks, and quarterly patient-specific mailings that are sent to providers. After 1 year of operation, testing rates increased 19% for hemoglobin A1c (HbA1c), 20% for lipids, and 78% for microalbumin. The actual mean HbA1c level decreased 0.5%, hospital admission rates decreased 22%, and hospital days were reduced 34%. Overall, the total medical costs per diabetic patient were reduced approximately 12%. Despite system cost increases for pharmacy costs, vendor contracting, case management administration, and patient and physician education, the potential for long-term quality improvement and considerable hospital cost reduction is high when such a plan is instituted. The program at John Deere Health Care is expanding and coverage has been enhanced.
authors.forename: B
authors.initials: B
authors.lastname: Steffens
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D019468:Disease Management; D005568:Forms and Records Control; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards*; D006801:Humans; D008499:Medical Records; D015146:Midwestern United States; D019982:Organizational Case Studies; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D013714:Tennessee; D016896:Treatment Outcome; D014768:Virginia