Health plans and other providers of disease management services might do better to emphasize the pursuit of better outcomes, rather than guaranteed savings, a new study implies.

"Return on Investment in Disease Management: A Review" says that there is just not enough data to determine whether DM saves money.

The study reviews literature on DM's cost-effectiveness, but the authors could find only 44 studies that contained enough detail to use.

"More information should be published about existing programs, and ideally the financial results should be subject to the same level of statistical rigor applied to studies focused on health outcomes," the study notes.

Ron Z. Goetzel, PhD, the lead author, is the director of the Institute for Health and Productivity Studies at Cornell University. He says that employers and health plans need "a sound business case to continue offering these programs." (For a look at the government's DM efforts, see our Legislation and Regulation department. Also see an interview with Al Lewis, president of the Disease Management Purchasing Consortium.)

Goetzel's study did not consider outcomes. "We assumed that following evidence-based clinical guidelines would improve the health and functioning of patients, though it is also acknowledged that all health care interventions may produce unintended consequences," the study states.

Evidence of cost-effectiveness seems stronger for some diseases than others.

"From a purely financial perspective, DM programs directed at patients suffering from CHF may save more money then they cost," the report says. "These programs produce a positive ROI, even in the short run." The cost of DM per CHF patient is $1,399, according to the report. The savings is $3,884.

On the other hand a look at the ROI for asthma, diabetes, and depression produced "mixed results." "For example," the report notes, "large-scale prevention programs directed at pre-diabetic patients (technically not DM programs) may cost more than they save, at least in the short run. On the other hand, diabetes DM programs directed at patients with active disease may produce savings and a positive ROI, although too few studies have been performed for these results to be conclusive."

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