Long-term Impact of a Chronic Disease Management Program on Hospital Utilization and Cost in an Australian Population with Heart Disease or Diabetes

Published in BMC Health Services Research

Author(s): G. Brent Hamar; Elizabeth Y. Rula; Carter Coberley; James E. Pope; and Shaun Larkin

Background: To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years.

Methods: The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups.

Results: Over the 4 year period, program participation resulted in significant reductions in hospital admissions (−11.4%, P < 0.0001), readmissions (−36.7%, P < 0.0001), and bed days (−17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia’s risk equalization system for private insurers.

Conclusions: Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

Key Takeaways:

• This long-term study of a chronic disease management program in Australia found significant reductions in hospital utilization and claims costs for insured members with heart disease or diabetes in each of the 4 years of the program.
• Average per-member savings across the 4-year period totaled $3,549; savings increased over time.
• Hospital utilization was significantly reduced over the 4 years:
• 11.4% reduction in hospital admissions
• 36.7% reduction in readmissions
• 17.2% reduction in hospital bed days
• The magnitude of program effect increased over time with respect to avoided admissions and bed days.
• Participants were 27% and 45% less likely to have any admission or readmission, respectively, over the 4-year study period than matched non-participants.
• Results from this study confirm and longitudinally extend previously published program utilization outcomes and add an evaluation of cost savings