Diabetes disease management in Medicare Advantage reduces hospitalizations and costs.
OBJECTIVE
To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD).


METHODS
Prospective unequal randomization design of 526 members from a Medicare Advantage segment of one region of a large national health plan from May 2005 through April 2007.


METHODS
High-risk and high-cost patients with diabetes and CAD who were enrolled in telephonic diabetes disease management were compared with a randomly selected comparison group receiving usual care. Wilcoxon signed-rank tests were used to compare the groups on all-cause hospital admissions, diabetes-related hospital admissions, all-cause and diabetes-related emergency department (ED) visits, and all-cause medical costs. Changes in self-reported clinical outcomes also were measured in the intervention group.


RESULTS
Patients receiving telephonic diabetes disease management had significantly decreased all-cause hospital admissions and diabetes-related hospital admissions (P <.05). The intervention group had decreased all-cause and diabetes-related ED visits, although the difference was not statistically significant. The comparison group had increased ED utilization. The intervention group decreased their all-cause total medical costs by $984.87 per member per year (PMPY) compared with a $4547.06 PMPY increase in the comparison group (P <.05). All clinical measures significantly improved (P <.05) in the intervention group.


CONCLUSIONS
A disease management program for high-risk patients with diabetes and CAD was effective in reducing hospital inpatient admission and total costs in a Medicare Advantage population.
Rosenzweig
James L
JL
Department of Medicine, Boston University, Boston, MA, USA.
Taitel
Michael S
MS
Norman
Gordon K
GK
Moore
Tim J
TJ
Turenne
Wendy
W
Tang
Pei
P
D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000639:trends*; D006801:Humans; D008297:Male; D020398:Medicare Part C; D011446:Prospective Studies; D014481:United States