SAN DIEGO—Medicare patients with diabetes and cardiovascular disease can significantly reduce both the cost of their medical care and rates of hospitalization by participating in a telephone-based diabetes disease management program, according to a study presented June 21 at The Endocrine Society’s 92nd Annual Meeting.
The disease management program took place in one year for a group of patients who were at least age 65 and who opted for a Medicare Advantage health plan with Health Net of Arizona. Because these patients had diabetes and heart disease, they were more likely to need future medical care and hospitalizations, said principal investigator James Rosenzweig, MD, a member of the scientific advisory board for Alere, the care management provider for Health Net of Arizona.
“More than 55 percent of all diabetes-related health care expenditures are for those ages 65 years and older, with Medicare covering much of this financial burden,” said Rosenzweig, who is an associate professor of medicine at Boston University School of Medicine. “Appropriate care could mitigate much of the suffering and cost associated with diabetes. However, only about 45 percent of persons with diabetes receive recommended care.”
The goal of Alere’s disease management program was to close gaps in care, such as lack of patient education, by providing patients with telephone support and information from nurse care managers, according to Rosenzweig. Nurses sent the patients’ primary care physicians summary reports before scheduled office visits and alerted them to changes in their patient’s health status.
Of the 526 patients whom the researchers contacted to participate in the study, 462 randomly selected patients were offered the disease management program (intervention) and 64 received usual care (control group). The health plan wanted most of its members to receive the intervention, Rosenzweig explained. The researchers analyzed data for all 462 patients they intended to treat, although 356 actually participated in the program.
Compared with controls, the intervention group had a significantly decreased number of inpatient hospital admissions for reasons relating to either diabetes or all causes, the authors reported. The intervention group also had a decline in the number of emergency room visits, but it was not statistically significant, probably because the control group was too small, Rosenzweig said.
Annual medical costs were almost $1,000 lower for each patient who received disease management services and more than $4,500 higher per control. The cost of the contracted disease management program was not included in the analysis, but Rosenzweig said “the savings were still substantial.”
Patients receiving the intervention also reported having better results of blood sugar control and cholesterol tests, fewer diabetic complications such as diabetic eye disease and foot ulcers, and better adherence to prescribed medications.
“These clinical measures demonstrate improved health status, which is the likely reason their medical costs and use of hospital services decreased,” he said.