Medicare Disease Management Programs Might Not Reduce Costs, Congressional Budget Office Says
There is "insufficient evidence" to back up assertions from some lawmakers and other health experts that disease management programs would reduce Medicare spending, according to a Congressional Budget Office report released Wednesday, CongressDaily reports (Heil, CongressDaily, 10/14).
For its analysis, CBO researchers examined studies on disease management programs for congestive heart failure, coronary artery disease and diabetes because they are common among Medicare beneficiaries and research has shown programs designed to treat the conditions have improved patients' health (CBO report, 10/13).
The report, requested by Senate Budget Committee Chair Don Nickles (R-Okla.), comes after lawmakers last year included a provision in the Medicare law to create a pilot program for beneficiaries to evaluate whether such preventive efforts can improve clinical results and decrease costs. If the pilot program is successful, disease management programs could become a permanent part of Medicare (CongressDaily, 10/14).
According to the CBO report, the results of research on disease management programs are "mixed and do not provide a firm basis" for the conclusion that additional screening, monitoring and educational efforts can lower overall Medicare spending by reducing use of acute care services. CBO found that "[a]ll in all, the evidence on cost savings is limited," partly because most studies have looked at improvement in care or in health and have not directly addressed costs, according to the report.
"The few studies reporting cost savings generally do not account for all health care costs, including the cost of the intervention itself," the study says. Even studies that show both improvements in patient health and cost savings might not be accurate gauges of disease management programs' ability to reduce costs for larger patient populations, according to the report.
While some evidence suggests programs can be "designed to reduce overall health costs for select groups of patients, little research exists that directly addresses the issues that would arise in applying disease management to the older and sicker Medicare population," the report says (CBO report, 10/13). CBO officials wrote in a letter to Nickles that the office will continue to monitor new research on disease management, including the results from the Medicare pilot program (CongressDaily, 10/14). The study is available online. Note: You must have Adobe Acrobat Reader to view this document.