Measuring Outcomes of a Chronic Obstructive Pulmonary Disease Management Program

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive disease of the lungs and is the fourth leading cause of death in the United States. It is characterized by decreasing elasticity of the airways with diminished lung function. The COPD disease management program is provided by a respiratory disease management company specializing in providing patient education, self-management tools and support, case management, and follow-up to members of contracted managed care organizations who have asthma and COPD. Begun in 1994, the program has provided services to over 200,000 such members through population-based programs since 1996. Out of 6,428 COPD patients who have been in the program for at least 90 days, those who report that their breathing interferes with their normal activities more than slightly decreased from 62% to 48% (p < 0.01). Those reporting nighttime awakening with shortness of breath more than occasionally decreased from 25% to 14% (p < 0.01), and those complaining of wheezing more than occasionally decreased from 24% to 13% (p < 0.01). One claims analysis showed a case mix and trend-adjusted net savings rate in a mixed commercial and Medicare COPD population of 16.7%. An analysis of a different health plan population shows total claims costs for a mixed commercial and Medicare HMO COPD population 11% lower at 1 year after implementing the program as compared with the previous year, after adjusting for the cost trend in the overall population. Savings were 5.4% after program fees. This article discusses the program's approach to outcomes data collection and analysis, and reviews its outcomes.