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Letter to the Honorable Don Nickles: An Analysis of the Literature on Disease Management Programs 1 (October 2004)

handle is hein.congrec/cbo9267 and id is 1 raw text is: CONGRESSIONAL BUDGET OFFICE Douglas Holtz-Eakin, Director U.S. Congress Washington, DC 20515 October 13, 2004 Honorable Don Nickles Chairman Committee on the Budget United States Senate Washington, DC 20510 Dear Mr. Chairman: In response to inquiries by you and your staff about whether disease management programs can reduce the overall cost of health care and how such programs might apply to Medicare, the Congressional Budget Office (CBO) has prepared the attached analysis. It examines peer-reviewed studies of disease management programs for specific conditions-congestive heart failure, coronary artery disease, and diabetes (selected in part because they are highly prevalent among Medicare beneficiaries)-and broader reviews of the relevant literature published in major medical journals. According to CBO's analysis, there is insufficient evidence to conclude that disease management programs can generally reduce overall health spending. It is important to note that such programs could be worthwhile even if they did not reduce costs, but CBO's analysis focused on the question of whether those programs could pay for themselves. The proposition that decreased use of acute care services might offset the costs of the screening, monitoring, and educational services in disease management programs is clearly appealing, but, unfortunately, much of the literature on those programs does not directly address health care costs. Instead, the focus is often on the processes of care or on intermediate measures of health, from which an overall impact on spending cannot reasonably be inferred. The few studies that report cost savings do so for controlled settings and generally fail to account for all health care costs, including the cost of the intervention itself. Furthermore, if disease management programs were applied to broader populations, the reported savings might not be attainable, and the programs could even raise costs. So while a few studies indicate that disease management programs could be designed to reduce overall health costs for select groups of patients (at least in the short term), little research directly addresses the issues that would arise in applying disease management to the older and sicker Medicare population. CBO will continue to monitor this research as new information becomes available-in particular, the results of disease management demonstration projects now being developed by the Centers for Medicare and Medicaid Services. www.cbo.qov

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