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Outcomes and lessons learned from evaluating TRICARE's disease management programs.
Am J Manag Care. 2010 Jun; 16(6):438-46.AJ

Abstract

OBJECTIVE

To share outcomes and lessons learned from an evaluation of disease management (DM) programs for asthma, congestive heart failure (CHF), and diabetes for TRICARE patients.

STUDY DESIGN

Multiyear evaluation of participants in voluntary, opt-out DM programs. Patient-centered programs, administered by 3 regional contractors, provide phone-based consultations with a care manager, educational materials, and newsletters. The study sample consisted of 23,793 asthma, 4092 CHF, and 29,604 diabetes patients with at least 6 months' tenure in the program.

METHODS

Medical claims were analyzed to quantify program effect on healthcare utilization, medical costs, and clinical outcomes. Multivariate regression analysis with an historical control group was used to predict patient outcomes in the absence of DM. The difference between actual and predicted DM patient outcomes was attributed to the program. A patient survey collected data on program satisfaction and perceived usefulness of program information and services.

RESULTS

Modest improvements in patient outcomes included reduced inpatient days and medical costs, and (with few exceptions) increased percentages of patients receiving appropriate medications and tests. Annual per patient reductions in medical costs were $453, $371, and $783 for asthma, CHF, and diabetes program participants, respectively. The estimated return on investment was $1.26 per $1.00 spent on DM services.

CONCLUSION

Findings suggest that the DM programs more than pay for themselves, in addition to improving patient health and quality of life. Lessons learned in program design, implementation, effectiveness, and evaluation may benefit employers contemplating DM, DM providers, and evaluators of DM programs.

Authors+Show Affiliations

The Lewin Group, Falls Church, VA 22042, USA. tim.dall@lewin.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

20560687

Citation

Dall, Timothy M., et al. "Outcomes and Lessons Learned From Evaluating TRICARE's Disease Management Programs." The American Journal of Managed Care, vol. 16, no. 6, 2010, pp. 438-46.
Dall TM, Askarinam Wagner RC, Zhang Y, et al. Outcomes and lessons learned from evaluating TRICARE's disease management programs. Am J Manag Care. 2010;16(6):438-46.
Dall, T. M., Askarinam Wagner, R. C., Zhang, Y., Yang, W., Arday, D. R., & Gantt, C. J. (2010). Outcomes and lessons learned from evaluating TRICARE's disease management programs. The American Journal of Managed Care, 16(6), 438-46.
Dall TM, et al. Outcomes and Lessons Learned From Evaluating TRICARE's Disease Management Programs. Am J Manag Care. 2010;16(6):438-46. PubMed PMID: 20560687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and lessons learned from evaluating TRICARE's disease management programs. AU - Dall,Timothy M, AU - Askarinam Wagner,Rachel C, AU - Zhang,Yiduo, AU - Yang,Wenya, AU - Arday,David R, AU - Gantt,Cynthia J, PY - 2010/6/22/entrez PY - 2010/6/22/pubmed PY - 2010/10/12/medline SP - 438 EP - 46 JF - The American journal of managed care JO - Am J Manag Care VL - 16 IS - 6 N2 - OBJECTIVE: To share outcomes and lessons learned from an evaluation of disease management (DM) programs for asthma, congestive heart failure (CHF), and diabetes for TRICARE patients. STUDY DESIGN: Multiyear evaluation of participants in voluntary, opt-out DM programs. Patient-centered programs, administered by 3 regional contractors, provide phone-based consultations with a care manager, educational materials, and newsletters. The study sample consisted of 23,793 asthma, 4092 CHF, and 29,604 diabetes patients with at least 6 months' tenure in the program. METHODS: Medical claims were analyzed to quantify program effect on healthcare utilization, medical costs, and clinical outcomes. Multivariate regression analysis with an historical control group was used to predict patient outcomes in the absence of DM. The difference between actual and predicted DM patient outcomes was attributed to the program. A patient survey collected data on program satisfaction and perceived usefulness of program information and services. RESULTS: Modest improvements in patient outcomes included reduced inpatient days and medical costs, and (with few exceptions) increased percentages of patients receiving appropriate medications and tests. Annual per patient reductions in medical costs were $453, $371, and $783 for asthma, CHF, and diabetes program participants, respectively. The estimated return on investment was $1.26 per $1.00 spent on DM services. CONCLUSION: Findings suggest that the DM programs more than pay for themselves, in addition to improving patient health and quality of life. Lessons learned in program design, implementation, effectiveness, and evaluation may benefit employers contemplating DM, DM providers, and evaluators of DM programs. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/20560687/Outcomes_and_lessons_learned_from_evaluating_TRICARE's_disease_management_programs_ L2 - https://www.ajmc.com/pubMed.php?pii=12664 DB - PRIME DP - Unbound Medicine ER -