Surprise: Disease Management Programs Don’t Work
OK, you probably aren’t surprised. Jason Shafrin on this study:
Washington, Texas, and Georgia have implemented diabetic disease management programs. The authors use a difference in difference strategy to measure whether costs and number of emergency admissions…decreased relative to states that did not implement diabetic disease management programs…The authors found no effect.
what exactly do these programs do? aim to increase patient awareness and responsibility over their health so they can make healthier decisions? Programs like this have begun to be implemented in various parts of the country with some success.
Which diabetes?
Oh lifestyle diseases and the nanny state.
21st century romance.
While the AHRQ has some good ideas (see http://www.ahrq.gov/qual/medicaidmgmt/medicaidmgmt1.htm for details), the burden of care rests firmly on the patients. If I was a patient with Medicare – ensuring that nearly all of my treatment expenses are covered anyway – I would have no incentive whatsoever to do any excess work on my own. If I’m going to the hospital anyway, why should I have to work harder than I already do to survive?
The opposite doesn’t necessarily help either. If we incentivise patients to stay healthy enough to avoid the hospital, then penurious patients may avoid care – even if they desperately need it. This perverse incentive may influence the elderly and infirm against seeking needed medical attention, so that they might have some extra money at the end of the year.
Our healthcare is indeed between Charybdis and Scylla.
These programs are not effective managed, correctly.
You posted a while back about Kaiser in Colorado: http://healthblog.ncpathinktank.org/how-kaiser-manages-high-blood-pressure/
The integration of EHR and disease management did seem to control disease.
“Some 83% of Kaiser Colorado’s hypertension patients now have their blood pressure under control. That is up from 61% when the health system launched the program in 2008.”
whole populations to affect a change in a few people generally outweighs the savings. The Center for Studying Health System Change published a great study on this topic. For employers, the benefits of health and wellness programs can take years to realize. Wellness programs also requires buy-in by upper management and leadership by example from the top down.
The problem with many of these programs is that their proponents assume a public health model can be used to solve an individual health problem. If — on the other hand — patients were spending their own money, selecting competing firms to help manage their conditions and adhering (or dropping out) at their own discretion and, the results might be very different.
Not sure how reflective this study is of other findings.