Related Experiment Videos
Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana
Journal of Medical Economics
|January 29, 2020
Summary
New disease management (DM) programs for chronic conditions like diabetes and heart disease proved cost-effective. These programs helped stabilize healthcare costs and showed potential for improved clinical outcomes in patients.
Area of Science:
- Health Economics
- Chronic Disease Management
- Clinical Outcomes Research
Background:
- Chronic diseases represent a significant financial and clinical burden on healthcare systems.
- Effective disease management (DM) strategies are crucial for mitigating this impact.
- This study focuses on DM programs for diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).
Purpose of the Study:
- To evaluate the clinical and economic impact of new DM programs.
- To assess the cost-effectiveness of DM interventions for major chronic disease groups.
- To identify trends in per member per month (PMPM) costs and total medical savings.
Main Methods:
- A comparative study design was used, comparing active DM program enrollees (IN group) with non-enrollees (OUT group).
- Data were collected from Blue Cross Blue Shield of Louisiana members aged 18-64 between March 2015 and February 2018.
- Multivariable models and difference-in-difference analysis were employed to compare PMPM costs and calculate medical savings over 1-3 years.
Main Results:
- Average PMPM costs remained stable for the IN cohort, while increasing for the OUT cohort over time.
- DM programs demonstrated potential for improving clinical outcomes, such as hemoglobin A1c levels.
- Significant PMPM savings were observed, reaching $53.72 after 3 years, with total savings exceeding $14.4 million for all programs combined.
Conclusions:
- Disease management programs for diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective.
- These programs show evidence of improving clinical outcomes.
- Implementing DM programs offers a viable strategy for managing chronic diseases and reducing healthcare expenditures.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:23Methods of Documentation V: CBE
Charting by Exception, or CBE, is a method of documentation used in healthcare, particularly in nursing, that focuses on documenting only significant or abnormal findings rather than recording every detail. This approach aims to streamline the documentation process, improve efficiency, and ensure that healthcare providers can quickly identify deviations from normalcy in patient assessments.
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...
01:15Methods of Documentation VI: Case Management Model
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
For example, a patient with a chronic illness...
01:29Documentation in Long-Term and Home Healthcare Setting
Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities
01:30Health Information Technology and Healthcare Information System
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:26Atherosclerosis III: Management
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...