A Framework for Disease Management ROI Studies: A Health-Plan Perspective

Abstract

Disease management programs generally target conditions that are high cost, that have a high prevalence, and that provide a clinical opportunity for effective intervention due to less than adequate compliance with national guidelines. Such conditions include asthma, diabetes, congestive heart failure, and cancer. The number of health plans with these programs, as well as the number of vendors that provide these services, has increased dramatically in the past few years. Disease management program goals include improving patient health while reducing medical costs. Although health plans, government agencies, and employer groups are very interested in the return-on-investment (ROI) for such programs, to date few ROI studies have been published. The findings of many are difficult to interpret due to small sample sizes and study design limitations. The goal of this article is to describe a framework for conducting a disease management program ROI study using examples from existing published research to illustrate important concepts. In describing the advantages and disadvantages of four different study designs, we attempt to portray the real world tradeoffs health plans make in conducting such studies. We hope this framework will be useful in designing ROI analyses for programs provided directly by health plans or through vendor contracts, and in interpreting the results of other published and nonpublished studies.