Commercial disease management models do not reduce Medicare costs in America

At a time when everyone is looking for ways to reduce health care costs in America, using commercial disease management programs to reduce the fee-for-service Medicare costs associated with chronic conditions among senior citizens seems like a practical approach.

Rather than managing chronic conditions with traditional care that includes physicians and clinical visits, commercial disease-management models rely on teams of health coaches, usually in remote call centers, to enhance beneficiaries' knowledge and ability to care for themselves as well as coordinate services across providers.

Unfortunately, commercial disease management models did not reduce hospital admissions or emergency room visits or result in cost savings in a study of nearly 250,000 Medicare patients conducted by researchers at RTI International for the Centers for Medicare and Medicaid Services.

The study is published in the Nov. 3 issue of the New England Journal of Medicine.

"While this would appear to be an innovative way to reduce Medicare expenditures, managing the care of older patients through telephone contact or an occasional visit does not achieve the cost savings Congress had hoped for when it mandated the Medicare Health Support Pilot Program," said Nancy McCall, ScD, a senior health economist at RTI International and the study's lead author. "Our results suggest that for such programs to be effective, they would need to be supplemented by intensive, costly, personal clinical attention."

The study, which included almost 250,000 patients randomly assigned to a commercial program for disease management or usual care, found that commercial disease-management companies had no success in reducing hospital admissions or emergency room visits among fee-for-service Medicare beneficiaries and had only limited success in improving the processes of care.

The results also showed that commercial disease-management programs achieved only modest improvements in quality-of-care measures and had no demonstrable reduction in the use of acute care or the costs of care.

The researchers suggest that the commercially based disease-management model may not work for Medicare, in part because the care of older, chronically ill patients is difficult to manage. They are more likely than younger people to have new acute conditions such as stroke, pneumonia or a hip fracture.

The authors also found that the health coaches in the disease-management program were not integrated into the patient's primary health care team, which hindered their ability to interact directly with the patient's primary care providers and facilitate changes in medical care plans made by the primary care provider.