A bare-bones asthma disease management program relying chiefly on the telephone and the U.S. Postal Service produced substantial savings for Colorado's Medicaid program, proving the efficacy of a basic communication and education program, according to a study performed by the National Jewish Medical Center in Denver.
"This was very low-tech," said David Tinkelman, M.D., vice president of health initiatives at National Jewish, who headed the study group. "It really works for both the urban and the rural populations."
The six-month study ran from October 2002 through May 2003 and compared data with that drawn from the same period the year before. It enrolled 258 asthmatics, more than three-fourths of them children under age 17.
Before the asthma program was implemented, the average baseline cost to the Colorado Medicaid program was $351.97 per asthma patient per month. Afterward, the average cost dropped to $220.84 per patient per month, including the $41 per month charge to run the DM program, for a 37% savings.
In comparison, Tinkelman said a second, independent control group that received no asthma DM services was studied. The control group was drawn from similar geographical areas as the study group, Tinkelman says. It started with an average baseline cost of $349.44 per patient per month and dropped to $266.09 per patient per month, a reduction of $83.35 or 23.8%, he says.
The fact that the second group generated somewhat lower costs without any DM intervention is explained by the concept of regression to the mean, according to Tinkelman, who teaches a course on understanding disease management statistics at the University of Colorado Health Sciences Center in Denver.
Members of both the study group and the control group were selected because they had asthma treatment events prior to the study period and a certain percentage of each were going to get better regardless, Tinkleman said.
Within the study group, 24% had severe asthma while the remainder had asthma considered to be mild or moderate.
As part of their DM services, nurses telephoned study-group members and evaluated the severity of their asthma, then provided them with over-the-phone counseling as well as written materials about their conditions. Enrollees were availed of a 24-hour hotline to talk about flare-ups or get other forms of information or counseling.
Reports about the DM plan and conversations between patients and program nurses were regularly sent to the enrollee's primary physician.
Other benefits comparing activities of study group members with their own earlier medical records include:
- An 85.8% drop in emergency room visits
- A 57.5% decline in unscheduled physician visits
- A reduction of more than 50% of school days missed for school-age survey participants
- A 90% drop in workdays missed by enrollee's parents and other caregivers
Medicaid populations, he said, "use the ER as their source of information, as their primary care, as their source of everything. If they can understand their disease and how they can handle it, that really makes a difference."
The Colorado Department of Health Care Policy and Financing, overseer of the state's Medicaid program, sponsored the study, which was funded by grants from pharmaceutical companies Novartis and AstraZeneca.