With healthcare costs soaring and attitudes toward tightly restricted managed care souring, employers are turning more and more toward disease management and intensive care management programs despite limited evidence such efforts save money or improve outcomes, a new report says.
The Center for Studying Health System Change, a nonpartisan, Washington-based research group funded by the Robert Wood Johnson Foundation, issued the findings today.
"In theory, if patients get the right care at the right time in the right place, it should help control costs and improve quality. In practice, however, evidence of disease management reducing costs and improving care is quite limited," says HSC President Paul Ginsburg.
However, employers apparently are not willing to wait for better information.
"Many employers admit that shifting health care costs to workers is a temporary fix at best," the report says. "With their resources on the line, employers will make judgments about the effectiveness of these programs, no matter how limited the data."
Citing a 2001 Health Affairs report, HSC researchers estimate 10% of patients account for 70% of healthcare spending. And according to the Institute of Medicine treatise, "Crossing the Quality Chasm," the care patients receive often is quite a bit different from evidence-based best practices.
"Like other innovations in healthcare delivery and management, disease management programs are difficult to evaluate systematically because they are rarely implemented consistently across health plans and vendors and often evolve over time," according to the study.
The report suggests that health plans and employers may be at odds when it comes to disease management because rapid enrollee turnover can force payers to emphasize short-term cost savings, while employers tend to focus on longer-term results.
"Lack of consistent evidence of improved quality and reduced costs has prevented more rapid acceptance of disease management programs, according to some employers," the researchers write.
HSC says disease management and intensive case management may work well in Medicare populations because of the prevalence of high-utilization enrollees with multiple chronic ailments and the low rate of turnover.