Disease management (DM) programs that help guide the care of patients with chronic health problems appear to improve the quality of healthcare, but there is little evidence that such efforts actually save money, according to a study by the RAND Corporation.

The study reviewed all past research on DM programs. Researchers selected 29 evaluations, systemic reviews and meta-analyses to focus on, covering 317 unique studies. That review found consistent evidence that DM programs can improve healthcare quality, improve disease control, and, in the case of patients with congestive heart failure, reduce hospital admission rates. But patients with depression who were enrolled in DM programs were more likely to use outpatient care and prescription drugs, increasing costs.

There is also little evidence about whether these programs improve health outcomes over the long term, researchers said.

Health insurance plans and employers nationally in 2005 spent about $1.2 billion on DM programs, with 96 percent of the top 150 U.S. health insurance companies offering some form of DM service.

The topic has also become a key point in the national healthcare reform debate, as policymakers search for a way to improve healthcare quality and access, while controlling costs at the same time.

The RAND study analyzed research on various DM programs and their effect on six chronic conditions: congestive heart failure, coronary artery disease, diabetes, asthma, depression and chronic obstructive pulmonary disease (COPD).

With the exception of asthma and COPD, which showed inconclusive results, researchers found consistent evidence that DM programs did improve the quality of healthcare.

There was also consistent evidence that patients with congestive heart failure and depression reported improved quality of life.

But evidence of cost-savings was inconclusive for most of the conditions, indicating that further research is needed. It is plausible that DM programs reduce costs for congestive heart failure patients because many programs reduce hospital admissions for these patients, researchers said.

In contrast, research has shown that patients with depression are commonly under-treated, so a DM program that actively screens for depression and encourages patients to get treatment will increase costs, researchers said.

Most of the studies reviewed followed patients only for about a year, which is not long enough to assess long-term health outcomes. For example, a DM program may improve a patient’s cholesterol levels in the short term, but it can take years to determine whether those interventions – assuming they were sustained for a long period – prevent heart attacks and costly hospitalizations years into the future.

Health insurance plans, employers and policymakers will also have to evaluate whether the benefits of DM programs are worthwhile, despite the lack of evidence for cost-savings.

Address: RAND Corporation, 1776 Main St., Santa Monica, CA 90401; (310) 393-0411, www.rand.org.

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