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Abstract

Health and disease management (HDM) programs have faced challenges in documenting savings related to their implementation. The objective of this eliminate study was to describe OptumHealth's (Optum) methods for estimating anticipated savings from HDM programs using Value Drivers. Optum's general methodology was reviewed, along with details of 5 high-use Value Drivers. The results showed that the Value Driver approach offers an innovative method for estimating savings associated with HDM programs. The authors demonstrated how real-time savings can be estimated for 5 Value Drivers commonly used in HDM programs: (1) use of beta-blockers in treatment of heart disease, (2) discharge planning for high-risk patients, (3) decision support related to chronic low back pain, (4) obesity management, and (5) securing transportation for primary care. The validity of savings estimates is dependent on the type of evidence used to gauge the intervention effect, generating changes in utilization and, ultimately, costs. The savings estimates derived from the Value Driver method are generally reasonable to conservative and provide a valuable framework for estimating financial impacts from evidence-based interventions. (Population Health Management 2013;16:356–363)

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References

Aldana

, Merrill

, Price

, Hardy

, Hager

. Financial impact of a comprehensive multisite workplace health promotion program. Prev Med, 2005, 40:131–137.

Care Continuum Alliance. Care Continuum Alliance definition of disease management. Available at: http://www.carecontinuumalliance.org/dm_definition.asp. Accessed January 21, 2013 .

Krause

. Economic effectiveness of disease management programs: A meta-analysis. Dis Manag, 2005; 8:114–134.

Kahn

, Robertson

, Smith

, Eddy

. The impact of prevention on reducing the burden of cardiovascular disease. Circulation, 2008; 118:576–585.

Weingartern

, Henning

, Badamgarav

, et al. Interventions used in disease management programmes for patients with chronic illness. Which ones work? Meta-analysis of published reports. BMJ, 2002:325:925–939.

Ofman

, Badamgarav

, Villagra

, Duffy

. Does disease management improve clinical and economic outcomes in patients with chronic disease? A systematic review. Am J Med, 2004; 117:182–192.

Congressional Budget Office. An analysis of the literature on disease management programs. Washington, DC: Congressional Budget Office; 2004.

Diamond

. DM's cost-effectiveness doubted in CBO report. Manag Care, 2004; 12:31–32, 35.

Linden

. What will it take for disease management to demonstrate a return on investment? New perspectives of an old theme. Am J Manag Care, 2006; 12:217–222.

10.

Linden

, Adams

, Roberts

. An assessment of the total population approach for evaluating disease management program effectiveness. Dis Manag, 2003; 6:93–102.

11.

Goetzel

, Ozminkowski

, Villagra

, Duffy

. Return on investment in disease management: A review. Health Care Financ Rev, 2005; 26:1–19.

12.

McCall

, Cromwell

. Results of the Medicare health support disease management pilot program. N Engl J Med, 2011; 365:1704–1712.

13.

Wilson

. Evaluating ROI in state disease management programs. State Coverage Initiat Issue Brief, 2003; 4:1–6.

14.

Care Continuum Alliance. Outcomes Guidelines Report, Volume 5. Washington, DC: Care Continuum Alliance; 2010.

15.

Lynch

, Chen

, Bender

, Edington

. Documenting participation in an employer-sponsored disease management program: Selection, exclusion, attrition, and active engagement as possible metrics. J Occup Environ Med, 2006; 48:447–454.

16.

Brophy

, Joseph

, Rouleau

. Beta-blockers in congestive heart failure. A Bayesian meta-analysis. Ann Intern Med, 2001; 134:550–560.

17.

Ingenix, Inc. Episode Treatment Groups. Decatur, GA: Ingenix, Inc.; 2008.

18.

Ryan

, McPeck

, Chapman

. Evidence-based programming: A practitioner's guide. Am J Health Promot, 2011; 25:TAHP1–TAHP9.

19.

Hunt

; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACA/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol, 2005:46:e1–e82.

20.

Coleman

, Parry

, Chalmers

, Min

. The care transitions intervention: Results of a randomized controlled trial. Arch Int Med, 2006; 166:1822–1828.

21.

Fourney

, Dettori

, Hall

, Hartl

, McGirt

, Daubs

. Systematic review of clinical pathways of lower back pain and introduction of the Saskatchewan spine pathway. Spine (Phila Pa 1976), 2011; 36:S164–S171.

22.

Wang

, McDonald

, Bender

, Reffitt

, Miller

, Edington

. Association of healthcare costs with per unit body mass index increase. J Occup Environ Med, 2006; 48:668–674.

23.

Billittier

, Moscati

, Janicke

, Lerner

, Seymour

, Olsson

. A multisite survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med, 1996; 3:1046–1052.

24.

Camasso-Richardson

, Wilde

, Petrack

. Medically unnecessary pediatric ambulance transports: A medical taxi service?. Acad Emerg Med, 1997; 4:1137–1141.

25.

Grumbach

, Keane

, Bindman

. Primary care and public emergency department overcrowding. Am J Public Health, 1993; 83:372–378.

26.

Yarris

, Moreno

, Schmidt

, Adams

, Brooks

. Reasons why patients choose an ambulance and willingness to consider alternatives. Acad Emerg Med, 2006; 13:401–405.

Value Drivers: An Approach for Estimating Health and Disease Management Program Savings

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