Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Abstract

Aims: Chronic diseases impose a substantial healthcare burden. This study sought to evaluate the clinical and economic impact of new disease management (DM) programs, targeting four major chronic disease groups: diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).

Materials and methods: Between March 1, 2015, and February 28, 2018, members with Blue Cross Blue Shield of Louisiana insurance were contacted and enrolled in a DM program if they were aged 18 years through 64 years, eligible for a DM program, and had not been previously enrolled in a DM program. Active enrollees of a DM program (“IN” group) were compared to members who were not yet enrolled (“OUT” group). Average per member per month (PMPM) costs were aggregated annually to document any descriptive trends. Multivariable model estimates were used to compare PMPM costs for all IN subjects and all OUT subjects. Total medical savings were evaluated for the following time intervals: 1–12 months, 13–24 months, and 25–36 months.

Results: For all four DM programs, average costs PMPM trended upward over time for the OUT cohort, while they remained relatively stable for the IN cohort. Some evidence also showed that DM programs improved clinical outcomes, such as hemoglobin A1c values. A difference in difference analysis showed PMPM savings for all four programs combined of $31.61, $50.45, and $53.72 after 1, 2, and 3 years, respectively. Multivariable modeling results showed total savings after 3 years of $14,460,174 for all DM programs combined.

Limitations: Although multivariable models adjusted for several clinical, demographic, and economic characteristics; it is possible that some important confounders were missing due to lack of data.

Conclusions: DM programs implemented to control diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective and show some evidence of improved clinical outcomes.

Keywords:

• Disease management
• chronic disease
• healthcare expenditures
• nurse intervention
• clinical outcomes

JEL CLASSIFICATION CODES:

• C31
• I13
• M21

Transparency

Declaration of funding

This study was funded by Blue Cross Blue Shield of Louisiana.

Declaration of financial/other relationships

This research was performed internally by Blue Cross Blue Shield of Louisiana and authors neither received outside funding nor do they have any competing financial interests. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Miao Liu, Jason Ouyang, Yuan Zhang, and Xiaojing Yuan were involved in the conception and study design, data interpretation, and contributed to the interpretation of the results. Jason Ouyang, Yuan Zhang, and Somesh Nigam assisted with data interpretation and critical revisions. Janet Chaisson, Tasha Bergeron, Dawn Cantrell, and Vindell Washington own the DM programs and provided clinical and operational details about each interventional program. All authors provided critical feedback and helped shape the research and analysis.

Acknowledgements

No assistance in the preparation of this article is to be declared.

Previous presentations

A version of this research was presented as a poster at the 2019 Blue Cross Blue Shield National Summit in Grapevine, TX, and the 2019 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conference in New Orleans, LO.