Administration and evaluation of a Hemophilia Treatment Center-administered disease management program for individuals with bleeding disorders insured by Indiana's high-risk insurance pool

Background: Indiana's high-risk insurance program, the Indiana Comprehensive Health Insurance Association (ICHIA), insured 45 individuals with bleeding disorders (BDs) in 2002 whose total healthcare costs were $19 million, largely attributable to clotting factor concentrate (CFC) costs. In 2003, the Indiana Hemophilia & Thrombosis Center collaborated with ICHIA to develop and implement a Hemophilia Treatment Center-administered disease management program (DMP) for ICHIA-insured individuals with BDs. Implemented October 2004, the DMP aimed to improve care quality while maintaining/lowering costs. Methods: Public Health Service pharmacies and pricing for CFC dispensations were instituted. Dispensations and patient-reported utilization were monitored and analyzed against expected/prescribed usage. Pharmacokinetic analysis enabled identification of opportunities to reduce CFC utilization/optimize coverage. Other methods included multidisciplinary clinical management, survey tool administration, and pharmacoeconomic evaluation. Results: Outcome measures include mean medical, hospital, and CFC costs; and numbers of emergency room (ER) visits and inpatient hospital (IP) days. Three years post-implementation, all costs remain below baseline, except hospital costs which increased in Year 3 due to two high-cost medically-necessary procedures. ER visits have been reduced for three consecutive years. Mean number of IP days was lower in Years 1 and 2 than in baseline, but increased in Year 3 due to the high-cost procedures and IP stays. Conclusion: Decreased costs were primarily attributable to decreased outpatient CFC costs and utilization; however, mean total costs remain 11.9% below baseline three years post-implementation, indicating DMP success in containing costs, improving care, increasing treatment adherence, and decreasing the need for emergency and IP care.