Commercial disease-management programs linked to limited, modest improvements

McCall N. N Engl J Med. 2011;365:1704-1712.

Results of a recent study suggest that commercial disease-management programs that use nurse-based call centers are associated with modest or no improvements in quality care measures, acute care and expenditures among fee-for-service Medicare beneficiaries.

In the Medicare Modernization Act of 2003, Congress required CMS to investigate the commercial disease-management model in the Medicare fee-for-service program, according to background information provided in the study. The Medicare Health Support Pilot Program was designed as a large, randomized study of eight commercial disease-management programs that used nurse-based call centers. Researchers randomly assigned patients with HF, diabetes or both to the intervention or usual-care (control) group. All patients were compared with the use of a difference-in-differences method to evaluate the effects of the programs on acute care utilization, Medicare expenditures for fee-for-service beneficiaries and quality of clinical care.

Overall, researchers analyzed data on 242,417 patients (163,107 were in the intervention group). According to results, the eight commercial disease-management programs studied had no effect on reduction of hospital admissions or ED visits for any condition and for ambulatory-care sensitive conditions as compared with usual care.

There were 14 significant improvements in process-of-care measures, based on 40 comparisons, according to the abstract. The researchers said these small improvements were associated with substantial costs to the Medicare program in fees paid to the disease-management companies ($400 million). Further, the improvements were not linked to demonstrable savings in Medicare expenditures on health services.

The researchers said the companies involved “had difficulties recruiting sicker beneficiaries into their intervention groups.

“In light of the results of other CMS disease-management programs and the unsuccessful interventions in this large, randomly designed study, it is unlikely that simply managing the care of elderly patients through telephone contact or an occasional visit will achieve the level of savings that Congress had hoped for when it mandated the Medicare Health Support Pilot Program,” the researchers concluded. “These findings also suggest that for such programs to be effective, they need to include intensive, costly, personal clinical attention.”

Disclosure: Dr. McCall reports no relevant financial disclosures. Dr. Cromwell reports that his institution, RTI International, is under contract to CMS to evaluate the Medicare Health Support Pilot Program.

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