Impact of disease management on cost-effectiveness of medicare spending

Findings from the third annual Tufts Center for the Study of Drug Development survey of 22 leading disease and pharmacy benefits managers suggest that incorporation of disease management into Medicare would lower hospital inpatient costs. However, it is unclear whether hospital cost savings would be sufficient to offset increases in pharmacy, physician, and outpatient expenditures as a result of an added combination disease management and pharmacy benefit. Furthermore, the survey indicates that the Centers for Medicare & Medicaid Services (CMS) would liked struggle in recruiting disease managers due to their limited enrollment of Medicare beneficiaries, relative inexperience with contracts that put disease managers at risk, and only sporadic use of randomized design studies to test and prove the efficacy of disease management interventions. Thirteen of the 22 survey respondents are currently considered early compliers per accreditation standards developed by the National Committee on Quality Assurance. However none of the 22 survey respondents comply with the stringent CMS requirements described in the solicitation for the 2002 disease management demonstration.