Washington state disease management program saves $13 million

An analysis of Washington State's disease management efforts shows a return-on-investment of $3 for every $1 spent on the program and a net savings of more than $13.3 million during the program's final year.

The program, operated by McKesson Health Solutions for the Washington Medical Assistance Administration, manages care for Medicaid beneficiaries with asthma, diabetes, congestive heart failure, and chronic obstructive pulmonary disease (COPD).

The state agency contracted with Milliman Consultants and Actuaries to compute the savings for the program period from August 2005 through June 2006. The program includes a 24/7 nurse advice line used by beneficiaries when they needed recommendations from registered nurses about acute medical issues.

Clinical outcomes were calculated by Qualis Health and included:

  • use of inhaled corticosteroid daily controller for asthma up from 55% to 70%;
  • asthma action plan up from 12% to 35%;
  • COPD action plan up from 10% to 26%;
  • early recognition of COPD exacerbation up from 34% to 59%;
  • HbA1c under control in diabetics up from 55% to 76%;
  • diabetics having an action plan up from 16% to 23%;
  • heart failure patients with a prescription for an ACE inhibitor up from 64% to 69%; and
  • heart patients not a current smoker up from 61% to 66%.

On beneficiary satisfaction surveys, users gave the program and its nurses high marks. Beneficiaries said they were "satisfied" or "very satisfied" with the nurses' ability to answer questions (95%), support and education (93%), and understanding of symptoms and related concerns (95%).

Some 92% said they were "comfortable" or "very comfortable" when talking with program nurses by phone and overall program satisfaction during the study period was 93%.