title: Can disease management target patients most likely to generate high costs? The impact of comorbidity.
abstract: BACKGROUND
  Disease management programs are increasingly used to manage costs of patients with chronic disease.
  
  
  OBJECTIVE
  We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs.
  
  
  METHODS
  Retrospective analysis of prospectively obtained data.
  
  
  METHODS
  A general medicine practice with both faculty and residents at an urban academic medical center.
  
  
  METHODS
  Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year.
  
  
  RESULTS
  Annual cost of diseases targeted by disease management.
  
  
  METHODS
  Patients' clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs.
  
  
  RESULTS
  Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs.
  
  
  CONCLUSIONS
  Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care.
authors: Division of General Internal Medicine, Center for Complementary and Integrative Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA. mecharl@med.cornell.edu
authors: Mary
authors: M
authors: Charlson
authors: Robert E
authors: RE
authors: Charlson
authors: William
authors: W
authors: Briggs
authors: James
authors: J
authors: Hollenberg
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000639:trends; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003365:Costs and Cost Analysis / Q000191:economics; D019468:Disease Management; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies