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Telephonic disease management program for high acuity seniors with coronary artery disease (CAD) and/or diabetes leads to lower costs and reduced inpatient lengths of stay

Sunday, November 3, 2013

John Li, PhD, MPH, Optum, Golden Valley, MN
Cynthia Taylor, BS, CS Clinical Solutions, OptumHealth Care Solutions, Minneapolis, MN
David Mosley, MHA, Medicare & Retirement Finance, UnitedHealthcare, Phoenix, AZ
Background: A telephonic disease management program targeting high acuity seniors with CAD and/or diabetes was implemented among 1,236,442 beneficiaries enrolled in Medicare Advantage plans. This retrospective matched cohort study examined outcomes for program participants in three areas: cost savings, utilization and quality metrics. Methods: Study participants were drawn from 102,146 members qualified for the program from 1/1/2010 through 12/31/2011. Intervention individuals (n=14,578) were those who engaged in the program. Control individuals (n=87,568) were those who were qualified but never engaged in the program. Intervention members were matched 1:1 with controls using propensity scores. Regression modeling was used to determine the impact of the program on outcomes. Results: Propensity score matching resulted in 9,337 intervention members and 9,337 controls balanced on 70 covariates. Engaged members had a mean post-engagement monthly reduction in medical expenses of $150 (95% CI $127 to $175), reduced inpatient length of stay (LOS) 8 vs. 9 days (p <0.001) and lower average cost on inpatient admission, $14,384 vs. $15,228 (p=0.07). Engaged members also had a 1.2 (95% CI 1.1 to 1.4) higher odds of closing selected HEDIS measure gaps compared to controls. Discussion: The program was associated with improved HEDIS quality of care metrics, while reducing post-engagement medical expenses among engaged participants. No significant decrease in inpatient admission was found for the intervention group; however, characteristics of an admission appeared to differ. Average LOS for inpatient admissions was shorter for those in the intervention group and average cost of an admission was lower, although borderline significant.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Describe the use of propensity score matching methods in identifying appropriate controls for members engaged in the telephonic intervention. Evaluate the impact of a telephonic nurse intervention on seniors with high acuity CAD and Diabetes. Identify health outcomes that were most impacted by nurse interventions.

Keyword(s): Disease Management, Elderly

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Li has been working in the public health field for over 10 years. His current area of concentration is health services research and evaluation of disease management programs. He received his Ph.D. in epidemiology from the University of Minnesota, School of Public Health. He also holds a Masters in Public Health from Tulane University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.