Caremark Publishes Disease Management Study on Patients with Diabetes

PBMs have been offering disease management programs for the past several years. PBMI's 2001 Prescription Drug Benefit Cost and Plan Design Survey Report finds that 44% of U.S. employers offer some type of PBM-related disease management program. The most frequently offered programs are for diabetes and asthma.

In conversations with employers about PBM disease management programs, employers raise primary concerns about the absence of a contractual relationship between the PBMs and the physicians involved, the impersonal design of many of the programs (e.g., limited to mailing education pieces to the patient), and the inability of PBMs to properly document the results of these programs.

While PBMs are communicating more frequently about the industry, few publish industry studies documenting individual outcomes of disease management programs. Caremark, Inc. has completed a study documenting the impact of its diabetes disease management program. The study was published in the summer 2001 issue of Disease Management, a peer-reviewed journal of outcomes studies. Read the entire article on Caremark's Web site at: www.caremark.com/company_ overview.

The individuals that participated in this program come from a population of 180,000 individuals enrolled in a self-insured indemnity health plan. Patients with diabetes were identified through a variety of means and were asked to voluntarily enroll in the disease management program. Of these, 2,745 enrolled and 8,978 did not. Medical claim data was tracked for both groups. The 8,978 individuals acted as a control group.

The program consisted of phone calls from nurse educators, educational mailings to the patients, and communication with the patients' physicians. Individuals identified as being "at risk" were managed more aggressively.

Interventions Decrease Costs

Caremark's program resulted in a 9.4% decrease in medical costs between the baseline year and the first year of the program. If projected medical cost increases are taken into account, the program actually resulted in a 17% decrease. During this same time period the control group experienced a 3% increase, which was slightly less than the projected increase.

It is encouraging to see this type of study being conducted and published by a PBM. The study shows that Caremark's disease management programs can yield savings by working closely with physicians and patients. Plan sponsors should look carefully at the design of their PBMs' disease management programs. The disease management program results reported by Caremark may be applicable to your benefit plan if the disease management programs have similar design and operation.

NOTE: Although PBMI periodically reports about specific PBMs and their services, PBMI does not endorse any PBM or PBM services, including those mentioned in this article.