Sunday, May 22, 2011

More On Disease Management Savings and Its Rationale in Risk Contracting

An early Disease Management Care Blog's scientific reaction to the Schwarzenegger imbroglio was to think of the Governor's ten year dalliance as a natural experiment, demonstrating that past anabolic steroid abuse doesn't necessarily necessarily interfere with long-term male fertility.  The DMCB spouse points out that the experiment also demonstrates that steroids have little impact on male intelligence

In keeping with the science theme of today's posting, the DMCB wanted to alert readers to the recent publication of two noteworthy studies:

1. Eapen and colleagues were interested in knowing if heart failure disease management programs make financial sense under a bundled payment system. Assuming a baseline readmission rate of just over 20% and a cost per readmission of about $2300, the authors calculate that a program cost of $477 per patient is the break-even point. The authors found 5 studies on the topic and determined that 2 would increase costs while 3 would be cost saving.  The DMCB suspects the disease management service providers will find charging less than $477 to be well within reach.  Hospital systems that are rushing into shared risk arrangements with insurers (including ACOs) that are asking the question poised by Eapen et al. now have their answer.

2. de Bruin and colleagues performed a systematic review of the recently (from 1/09 thru 12/09) published literature on "disease management" that included two or more components of the Wagner chronic care model.  31 papers were included (14 diabetes, 4 depression, 8 heart failure and 5 COPD).  21 of the 31 reported on costs and 13 showed cost-savings.   The authors concluded the range of cost shifts, ranging from +$3305 to -$16,996, indicates the evidence of cost expenditure reduction is "still inconclusive."  The DMCB thinks differently, noting that a "13" out of "21" saving money translates to about 2 out of 3.  To paraphrased Jack Nicholson's portrayal of the brave U.S. President Land in that DMCB cinematic fav, Mars Attacks!, "the people should know that two out of three ain't bad."  Indeed.

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