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PAPER OF THE WEEK: From 2007, Disease Management Is Not Cheap or Easy


Amid the disappointment that the Camden Coalition's "hot spotting" efforts did not reduce hospital readmissions, we note how a well-read 2007 paper in our archives showed that expenditures on disease management do not always produce a return on investment.

Welcome to “Paper of the Week,” which looks back at some of the most influential research articles and commentary that have appeared in The American Journal of Managed Care® over the past 25 years, and why they are important today.

There was great disappointment earlier over results in the New England Journal of Medicine regarding work by Jeffrey Brenner, MD, and the Camden Coalition. Called “hot spotting,” these efforts attempt to reduce hospital readmissions by identifying frequent users of medical care and directing them to social support services. The results showed that hospital readmissions did not go down, despite the Coalition’s efforts. But the results might not be a surprise to readers of our paper of the week.

This week’s paper, from 2007, asked the question, “Evidence for the Effect of Disease Management: Is $1 Billion a Year a Good Investment?”

This review article examined data from disease management programs in diabetes and congestive heart failure, as well as large-scale population health studies over a 15-year period.

The authors noted, “We found consistent evidence that disease management improves processes of care and disease control but no conclusive support for its effect on health outcomes. Overall, disease management does not seem to affect utilization except for a reduction in hospitalization rates among patients with congestive heart failure and an increase in outpatient care and prescription drug use among patients with depression.…"

“…When the costs of the intervention were appropriately accounted for and subtracted from any savings, there was no conclusive evidence that disease management leads to a net reduction of direct medical costs,” the authors added. The American Journal of Managed Care®, 2007.

Results in 2007 and today show that addressing social determinants of health is a complex process, and as Dr Brenner said, “These patients are hard to treat.”

To read our Paper of the Week, visit ajmc.com.

For more on complex patients, see our interview with Dr Brenner.

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