The impact of disease management on outcomes and cost of care: A study of low income asthma patients

An asthma disease management program designed specifically for low-income p atients experiencing significant adverse events can improve health outcomes substantially, while lowering costs. The Virginia Health Outcomes Partners hip aimed to help physicians in a fee-for-service primary care case managem ent program manage asthma in Medicaid recipients. Approximately one-third o f physicians treating asthma in an area designated as the intervention comm unity volunteered to participate in training on disease management and comm unication skills. This large-scale study discovered that the rate of emerge ncy visit claims for patients of participating physicians who received feed back reports dropped an average of 41% from the same quarter a year earlier , compared to only 18% for comparison community physicians. Although only a third of the intervention community physicians participated in the trainin g, emergency visit rates for all intervention community physicians nonethel ess declined by 6% relative to the comparison community among moderate-to-s evere asthma patients when date for participating and nonparticipating phys icians were combined. At the same time, the dispensing of some reliever dru gs recommended for asthma increased 25% relative to the comparison communit y. A cost-effectiveness analysis projected direct savings to Medicaid of $3 to $4 for every incremental dollar spent providing disease management supp ort to physicians. The results of this study demonstrate the potential this program offers, especially for Medicaid programs in other states that want to improve the care of their primary care case management networks and, at the same time, manage costs.