Evidence still out on disease management as cost saver

Supporters say early research proves the programs' value in boosting health and paring costs, but a study says it's too early to be sure.

By Robert Kazel, AMNews staff. Oct. 27, 2003.

Cost-conscious employers and health plans are increasingly offering patients disease management programs for chronic illnesses such as diabetes and congestive heart failure, but very limited evidence has been produced to prove the programs save money, a new report says.

The report by the Center for Studying Health System Change doesn't make judgments about the effectiveness of disease management, nor does it discourage employers from using them as a cost-cutting tool. But it observes that the numerous companies that pay for these programs are largely making a "leap of faith" that disease management actually lowers costs by improving health outcomes.

That leap of faith has been especially vigorous recently. The total revenue of specialty disease management firms rose from $85 million in 1997 to $600 million in 2002, the study said.

Disease management in theory has "a very substantial basis behind it" and "no one is against it," said Paul Ginsburg, PhD, president of the Washington, D.C.-based policy research organization that produced the report. AMA policy encourages the use of disease management programs provided they follow a list of ways physicians must be involved; for example, physicians may not be overruled by nonphysicians.

Plan sponsors appear to be "voting with their feet" by adopting the programs in greater numbers, Dr. Ginsburg said. But the growth would be even stronger if employers had better proof of future savings, he added.

"I don't mean the evidence is negative -- there just isn't much there," Dr. Ginsburg said.