Medicaid Costs Drop, Patient Health Improves in National Jewish Pilot Project
FEBRUARY 16, 2004
DENVER — Costs for treating asthma patients under Colorado's Medicaid program can drop significantly when those patients are enrolled in a comprehensive disease management program.
This conclusion comes from results released today of a pilot program managed by National Jewish Medical and Research Center in Denver. The data was unveiled at a news conference in Denver with Colorado Governor Bill Owens, and National Jewish officials Lynn M. Taussig, MD, President and CEO, and David Tinkelman, MD,Vice President of Health Initiatives.
The pilot program was designed to test the clinical and cost effectiveness of enrolling Medicaid asthma patients in a disease management program. It was sponsored by the Colorado Department of HealthCare Policy and Financing, which oversees the state's Medicaid program, and was funded by unrestricted educational grants from pharmaceutical companies Novartis and AstraZeneca.
"I have long been an advocate for exploring the potential of improved disease management, and this pilot program is an important step," said Gov. Owens. "We have found that it is possible to contain rising medical costs and improve the quality of care for our Medicaid clients."
The study included 258 asthmatics enrolled in Medicaid from throughout Colorado. Most had mild or moderate asthma, but 24 percent were considered severe. More than three quarters were children under 17.
Analysis of the six-month study shows a total dollar savings, over and above the cost of the program, of $202,991.00, or 37.4 percent, compared to baseline costs. That translates into an average cost per patient of $220.84 per month, including the $41 per patient per month cost of the disease management program. That compares to a per person monthly cost of $351.97 for those same patients prior to enrollment. This translates to a Return on Investment of 3.15.
In addition, after being enrolled in the program, participants reported an 85.8 percent reduction in emergency room visits; a 57.5 percent drop in unscheduled physician visits; and a 54.5 percent drop in hospitalizations. The number of days children missed from school dropped by more than one-half, and their caretakers missed 90 percent fewer days of work.
During the program, National Jewish provided tailored asthma education and telephone support to caregivers, parents, and participants in the Colorado Medicaid fee-for-service program, and provided physicians with ongoing clinical reports regarding the status of their patients' health and educational needs.
The disease management program relied primarily on written materials and proactive phone calls to help asthma patients better understand and manage their asthma.
Via the phone, registered nurses evaluated the severity of patients' asthma, their knowledge of the disease, and their ability to manage an asthma episode. They then helped patients develop detailed, customized plans to monitor and manage their disease, and sent patients a variety of educational materials and a peak flow monitor, if needed.
Periodically, nurses called patients to see how they were doing, encouraged them to stick with their plans, and answered any questions. In addition, patients who had questions or problems could contact the call center 24 hours a day, seven days a week. To help coordinate care with patients' primary care physicians, National Jewish sent physicians written reports after each telephone contact.
The study evaluated past claims data from Colorado Medicaid for a six-month period to establish a baseline, including treatment costs, hospitalization, emergency room utilization, and other data.
It then compared that baseline data to information on the same people for a corresponding six-month period when they were enrolled in the disease management program. The comparison looked at the same six-month intervals in consecutive years to account for seasonal changes in symptoms and treatment.
"These results are extremely promising," said Dr. Tinkelman, principal investigator of the study. "They strongly suggest that providing disease management services to all Colorado Medicaid asthma patients would result in considerable cost savings for the Medicaid program, as well as better health and quality of life for patients."