Disease Management Evaluation and Outcomes: The Case of Florida: A Healthy State

Background and Objective The Disease Management (DM) literature has called for an increased emphasis on program evaluation and development of sophisticated methodologies to address questions about program efficacy and Return on Investment (ROI). We describe our comprehensive approach to the evaluation of the Florida: A Healthy State program, review methodologies used, and report our outcomes.

Methods: Florida: A Healthy State (FAHS) was launched in 2001 as a partnership between the State of Florida and Pfizer Inc to reduce rapidly growing health care costs by improving the health of chronically ill Medicaid beneficiaries. FAHS collects information from patient claims, pre-authorization databases, lab records, and patients to capture self-reported behaviors and symptoms, patient knowledge, clinical information, utilization and costs. We employ concurrent analysis of operations and retrospective outcomes studies to demonstrate behavioral, clinical, utilization, and financial effectiveness. We perform pre/post analysis, matched pairs analysis, and analysis of performance against projections from statistical and epidemiological models.

Results: Over 180,000 Medicaid beneficiaries were eligible for FAHS, with nearly 24,000 under active care management. Care Managed beneficiaries demonstrated a 21% increase in medication adherence, sustained clinical improvement across four disease states managed, and reductions in overall hospitalizations and emergency room visits by 28 and 12% respectively. Additionally, there have been significant patient and physician satisfaction outcomes.

Conclusions and Implications: Although not always practical to utilize an experimental randomized controlled trial to evaluate a DM intervention; comprehensive evaluation strategies as demonstrated through FAHS provide the ability to engage in continuous quality improvement and demonstrate program effectiveness.