Diabetes disease management in managed care organizations.
Recent clinical trials and disease management programs sponsored by managed care organizations have demonstrated achievements in limiting complications, improving health measures, reducing costs, and enhancing the quality of life of the person with diabetes. In one managed care organization, Group Health, Inc., persons with diabetes received discounted supplies and educational material as encouragement to participate in a diabetes disease management program [Disease Management Solutions (DMS)]. Health risk appraisals (HRAs) were provided at enrollment, and at 6-month intervals thereafter. Over 8,000 persons with diabetes participated in the DMS program over a 2 and 1/2-year period. Claims data over a 3-year period (pre- and post-enrollment) for 1,368 persons with diabetes demonstrated that participation in DMS resulted in greater utilization of primary care services by enrolled persons than by non-enrolled, but a lower increase in costs for those enrolled. In addition to evaluating the program impact through changes in services and costs, HRAs provided self-reported scores on (1) several compliance measures and (2) general health impressions and productivity. In the DMS population, self-reported compliance with physician-recommended office visits and tests (eg, cholesterol screening) improved for persons with diabetes once they enrolled in the program. Participants also reported greater productivity (eg, fewer missed work days) once enrolled in the program. To validate self-reported results, medical claims were used to verify compliance with general office, ophthalmologic, and emergency room visits and hospital admissions. A high level of validity between self-reported results and claims data recording office and emergency room visits and hospital admissions was found.
Lynne
Donna
D
Group Health Inc., New York, New York 10001, USA. dlynne@ghi.com
D001786:Blood Glucose / Q000032:analysis; D003363:Cost Control; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics / Q000628:therapy; D019468:Disease Management; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D015397:Program Evaluation; D011788:Quality of Life; D014481:United States
D001786:Blood Glucose; D006442:Glycated Hemoglobin