Technology-Based Disease Management: A Low-Cost, High-Value Solution for the Management of Chronic Disease
Wally H. Gomaa
Background: Although information technology applications are part of all disease management programs, most programs involve extensive nurse interventions. Objective: To present clinical and financial outcomes data from One Health Plan's technology-based program(s), which provide asthma, diabetes mellitus, and cardiovascular care to over 90 000 participants. Methods: The programs are designed to support the health plan's patient population with asthma, diabetes, congestive heart failure, and coronary artery disease. Data from the health plan's medical and pharmaceutical claims were used to identify the total patient population. The program(s) use extensively mail, Internet, and Interactive Voice Response (IVR) services with only limited nurse interventions to engage the patients and intervene in their care. Patient engagement consisted of an introductory mailing supported by follow-up mailing. The objective was for the targeted patient to respond by completing a survey on paper, over the Internet, or via IVR. The CareResults SM program, uses participant-reported information to risk stratify the population and to track patients progress as part of the measurements of the program's results. The risk stratification algorithm scores the participant's clinical status and ability to self-manage their care. Both dimensions impact the participant's risk score, which in turn determines the follow-up activities. CareResults SM mails a personalized feedback booklet as part of a care kit to educate the participant on the current treatment protocols. The goal is to help the participant recognize good healthcare and teach them to work with their physicians to achieve this. Results: The programs demonstrate that improved outcomes can be rapidly achieved for a large number of participants without costly nurse interventions. One Health Plan offered the program to over 250 000 members in the year 2000 and had over 93 000 elect to participate. Improved clinical outcomes were demonstrated for asthma, diabetes, and the cardiovascular diseases. Highlights include a 55.2% increase in candidates with diabetes receiving glycosylated hemoglobin A1c test, and a 27% self-reported increase in the use of low-dose aspirin for participants with a cardiovascular condition. Financially, current analysis comparing 1999 costs to 2000 costs indicates that the program's per member per year net savings ranged from $US300 to $US1000 depending on the specific disease state. In all cases, the programs demonstrated a significant positive gross saving. Conclusion: One Health Plan's experience demonstrates that the technology-based CareResults SM program produces positive financial and clinical results without significant nurse interventions.
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