Disease management may not cut health costs.

Studies of disease management programs fail to provide any conclusive evidence they cut healthcare costs, though the programs may be of value even if they don't, according to the Congressional Budget Office (CBO).

In response to a request by the Senate Budget Committee, the CBO reviewed the literature on disease management to determine whether the programs reduce the overall cost of health care and if they could be used to lower spending by Medicare, the federal healthcare system for seniors. The review found that most of the literature on disease management focuses on processes of care, such as patients' adherence to testing or exam guidelines, or on intermediate measures of health, such as changes in blood pressure or cholesterol levels. The few studies that address healthcare spending generally used controlled settings and failed to account for the additional costs of the programs' screening, monitoring, and educational services.

"The proposition for disease management programs is that better care translates into improved health and, perhaps, to lower-cost care in the future," the CBO report states. "But because the programs directly influence only processes of care, causal links to health outcomes or to economic outcomes may be uncertain or could take several years to become evident."

Disease management programs have become popular in recent years among health plans and organizations seeking to improve the care of patients with chronic diseases (e.g., diabetes and congestive heart failure) and curb the growth of their healthcare costs. They typically feature the following elements:

* Educating patients about their disease and how they can better manage it, such as by using medications properly and changing certain behaviors;

* Monitoring patients' symptoms and treatment plans and ensuring such plans adhere to evidence-based guidelines; and

* Coordinating care among all providers, including physicians, hospitals, and pharmacies.

The assumption underlying disease management programs is that identifying chronic diseases sooner and treating them more effectively will slow their development and thereby result in lower spending. The CBO analysis found little evidence, however, that this assumption is correct.

"Improving health outcomes and mitigating healthcare costs do not necessarily go hand in hand, and disease management programs may be a worthwhile investment even if they do not reduce overall healthcare spending," the report concludes. "All in all, the evidence on cost savings is limited. The few studies reporting cost savings generally do not account for all healthcare costs, including the cost of the intervention itself.

Furthermore, these savings were achieved in controlled and limited settings, but if disease management programs were applied to broader populations, such savings might not be attainable and the programs could even raise costs."

The report, "An Analysis of the Literature on Disease Management Programs," is available on the CBO's Web site, www.cbo.gov