Diabetes care management program lowered health care costs, hospitalizations

The Endocrine Society 92nd Annual Meeting

SAN DIEGO — A telephone-based diabetes disease management program was associated with significant reductions in health care costs and rates of hospitalization for Medicare patients with diabetes and cardiovascular disease.

James L. Rosenzweig, MD, presented the results of a study that evaluated the efficacy of a high-intensity, telephonic, nurse-based, diabetes disease management program on quality measures of care and cost in a group of older patients.

Researchers randomly assigned 526 patients with diabetes aged 65 years and older to a diabetes disease management program or usual care for 1 year.

The goal of the diabetes disease management program was to close gaps in care, such as a lack of patient education, by providing patients with telephone support and information from nurse care managers. Nurses sent the patients’ primary care physicians summary reports before scheduled office visits and alerted them to changes in patient health status. Home glucose monitoring data were transmitted to care managers for a subgroup of high-risk patients.

Compared with the usual care group, patients who participated in the diabetes disease management program had a significantly decreased number of all-cause or diabetes-related inpatient hospitalizations (P<.05).

“All-cause inpatient admissions in the intervention group declined substantially by about one-third whereas there was little or no change in all-cause inpatient admissions in the control group over the course of 1 year,” Rosenzweig, director of diabetes services at Boston Medical Center, said at a press conference.

The management program was also associated with a decline in the number of emergency department visits.

All-cause total medical costs decreased by $984,870 per thousand members per year for the management program group compared with $4,547,065 per thousand members per year for the usual care group (P<.05).

“The actual costs in the intervention group declined by about $1,000 per patient per year whereas in the control group costs substantially increased by about $5,000 per patient per year, suggesting that this kind of intervention could potentially involve savings of perhaps $6,000 per patient per year,” Rosenzweig said.

The cost of the contracted diabetes disease management program was not included in the analysis, but Rosenzweig said “the savings were substantial.”

Patients assigned to the management program also reported improvements in glycemic control and cholesterol levels, fewer diabetic complications and better adherence to prescribed medications.

“Effective diabetes health management programs that manage patients with diabetes and all of its comorbidities can produce short-term clinical improvement and cost savings in the elderly population,” Rosenzweig concluded. – by Katie Kalvaitis

Today we are experiencing significant crises around caring for individuals with diabetes. There are fewer and fewer endocrinologists available to care for patients and the reimbursement for their services is dwindling. Furthermore, they receive no reimbursement for providing education services and counseling, which are really what patients need. People are trying to figure out how to do this and how to do it in a cost-effective way. Potentially, if a payer says it makes sense to pay for an outside firm or disease management company to treat patients with diabetes, it offloads the pressure from the physician. Cost is fundamentally going to drive these issues.

– Henry Anhalt, MD

Director of the Division of Pediatric Endocrinology and Diabetes,
Saint Barnabas Medical Center, Livingston, N.J.

For more information:

Rosenzweig JL. P3-715. Presented at: The Endocrine Society 92nd Annual Meeting and Expo; June 19-22, 2010; San Diego.