title: Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis.
abstract: The objective was to determine whether automated telephone self-management support (ATSM) for low-income, linguistically diverse health plan members with diabetes affects health care utilization or cost. A government-sponsored managed care plan for low-income patients implemented a demonstration project between 2009 and 2011 that involved a 6-month ATSM intervention for 362 English-, Spanish-, or Cantonese-speaking members with diabetes from 4 publicly funded clinics. Participants were randomized to immediate intervention or a wait-list. Medical and pharmacy claims used in this analysis were obtained from the managed care plan. Medical claims included hospitalizations, ambulance use, emergency department visits, and outpatient visits. In the 6-month period following enrollment, intervention participants generated half as many emergency department visits and hospitalizations (rate ratio 0.52, 95% CI 0.26, 1.04) compared to wait-listed participants, but these differences did not reach statistical significance (P=0.06). With adjustment for prior year cost, intervention participants also had a nonsignificant reduction of $26.78 in total health care costs compared to wait-listed individuals (P=0.93). The observed trends suggest that ATSM could yield potential health service benefits for health plans that provide coverage for chronic disease patients in safety net settings. ATSM should be further scaled up to determine whether it is associated with a greater reduction in health care utilization and costs.
authors.affiliation: 1 Division of General Internal Medicine at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.|2 UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.
authors.forename: Judy
authors.initials: J
authors.lastname: Quan
authors.affiliation: 2 UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.
authors.forename: Alexandra K
authors.initials: AK
authors.lastname: Lee
authors.affiliation: 1 Division of General Internal Medicine at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.|2 UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.|3 Division of Preventive Medicine and Public Health, Department of Epidemiology and Biostatistics, University of California , San Francisco, California.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Handley
authors.affiliation: 1 Division of General Internal Medicine at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.|2 UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.affiliation: 1 Division of General Internal Medicine at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.|2 UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.affiliation: 4 Philip R. Lee Institute for Health Policy Studies, University of California , San Francisco, California.
authors.forename: Samuel
authors.initials: S
authors.lastname: Tseng
authors.affiliation: 1 Division of General Internal Medicine at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.|2 UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California , San Francisco, California.
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006285:Health Planning / Q000379:methods*; D006296:Health Services / Q000191:economics*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D012189:Retrospective Studies; D012648:Self Care; D013689:Telephone
chemical_list: D007004:Hypoglycemic Agents