Controlling costs of chronic conditions is a hot button issue and some researchers are finding low-hanging fruit that can help reduce dollars spent on diseases like diabetes. At the annual Endocrine Society meeting in San Diego Monday, researchers reported a simple way to cut the $174 billion annual direct and indirect cost of diabetes: giving patients phone calls to counsel them.
Researchers--led by Dr. James Rosenzweig--conducted a prospective controlled study of 526 Medicare Advantage program members who had both diabetes and coronary-artery disease. High-risk and high-cost patients with both problems were randomized into an intervention group or a control group, and the two groups were monitored for hospital admissions--whether diabetes related or not; emergency department visits (again regardless of cause); and the cost of medical care, regardless of cause.
The intervention group received telephone-based disease management provided by Alere, the care management provider for Health Net of Arizona. The results were significant, with their medical costs dropping by nearly $1 million per thousand members annually--roughly $1,000 per patient--compared to a $4.5 million increase in the control group. A1C, LDL and microalbumin levels improved for the group from baseline, as did results of retinal and foot exams, ACE or ARB use, and aspirin use. There was no statistical difference in the groups for emergency department visits, although there were fewer visits in the intervention group. The size of the control group--just 64 people--may have been a factor in the lack of significant difference. If larger, it's possible that ED visits would show a statistically meaningful decline.
The annual cost of diabetes care--direct and indirect--is nearing $200 billion, and over half of that comes from patients 65 and older. Despite that, Rosenzweig and his colleagues at Boston University stated in their presentation that fewer than half of diabetes patients get their recommended care. The reason? Inconsistent quality, a lack of patient education and inadequate support for patients to help manage their own disease using tools like meal planning, appropriate monitoring, smoking cessation, and getting weight under control. Medication adherence and regular exercise are also factors in the uneven care, Rosenzweig and his colleagues noted.