Outcomes and lessons learned from evaluating TRICARE's disease management programs.
OBJECTIVE
To share outcomes and lessons learned from an evaluation of disease management (DM) programs for asthma, congestive heart failure (CHF), and diabetes for TRICARE patients.


METHODS
Multiyear evaluation of participants in voluntary, opt-out DM programs. Patient-centered programs, administered by 3 regional contractors, provide phone-based consultations with a care manager, educational materials, and newsletters. The study sample consisted of 23,793 asthma, 4092 CHF, and 29,604 diabetes patients with at least 6 months' tenure in the program.


METHODS
Medical claims were analyzed to quantify program effect on healthcare utilization, medical costs, and clinical outcomes. Multivariate regression analysis with an historical control group was used to predict patient outcomes in the absence of DM. The difference between actual and predicted DM patient outcomes was attributed to the program. A patient survey collected data on program satisfaction and perceived usefulness of program information and services.


RESULTS
Modest improvements in patient outcomes included reduced inpatient days and medical costs, and (with few exceptions) increased percentages of patients receiving appropriate medications and tests. Annual per patient reductions in medical costs were $453, $371, and $783 for asthma, CHF, and diabetes program participants, respectively. The estimated return on investment was $1.26 per $1.00 spent on DM services.


CONCLUSIONS
Findings suggest that the DM programs more than pay for themselves, in addition to improving patient health and quality of life. Lessons learned in program design, implementation, effectiveness, and evaluation may benefit employers contemplating DM, DM providers, and evaluators of DM programs.
Dall
Timothy M
TM
The Lewin Group, Falls Church, VA 22042, USA. tim.dall@lewin.com
Askarinam Wagner
Rachel C
RC
Zhang
Yiduo
Y
Yang
Wenya
W
Arday
David R
DR
Gantt
Cynthia J
CJ
D001249:Asthma / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D019985:Benchmarking; D003920:Diabetes Mellitus / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D019468:Disease Management; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research; D006333:Heart Failure / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D007344:Insurance Claim Reporting; D007902:Length of Stay / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000458:organization & administration*; D008889:Military Personnel / Q000523:psychology; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D017060:Patient Satisfaction; D015397:Program Evaluation / Q000379:methods; D012044:Regression Analysis