The Impact of Population-Based Disease Management Services on Health Care Utilisation and Costs: Results of the CAPICHe Trial
Disease management programmes may improve quality of care, improve health outcomes and potentially reduce total healthcare costs. To date, only one very large population-based study has been undertaken and indicated reductions in hospital admissions > 10%.
We sought to confirm the effectiveness of population-based disease management programmes. The objective of this study was to evaluate the relative impact on healthcare utilisation and cost of participants the Costs to Australian Private Insurance – Coaching Health (CAPICHe) trial.
Parallel-group randomised controlled trial, intention-to-treat analysis
Forty-four thousand four hundred eighteen individuals (18–90 years of age) with private health insurance and diagnosis of heart failure, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, or low back pain, with predicted high cost claims for the following 12 months.
Health coaching for disease management from Bupa Health Dialog, vs Usual Care.
Main Outcome Measures
Total cost of claims per member to the private health insurer 1 year post-randomisation for hospital admissions, including same-day, medical and prostheses hospital claims, excluding any maternity costs. Analysis was based on the intent-to-treat population.
Estimated total cost 1 year post-randomisation was not significantly different (means: intervention group A$4934; 95% CI A$4823–A$5045 vs control group A$4868; 95% CI A$4680–A$5058; p = 0.524). However, the intervention group had significantly lower same-day admission costs (A$468; 95% CI A$454–A$482 vs A$508; 95% CI A$484–A$533; p = 0.002) and fewer same-day admissions per 1000 person-years (intervention group, 530; 95% CI 508–552 vs control group, 614; 95% CI 571–657; p = 0.002). Subgroup analyses indicated that the intervention group had significantly fewer admissions for patients with COPD and fewer same-day admissions for patients with diabetes.
Chronic disease health coaching was not effective to reduce the total cost after 12 months of follow-up for higher risk individuals with a chronic condition. Statistically significant changes were found with fewer same-day admissions; however, these did not translate into cost savings from a private health insurance perspective.
KEY WORDSdisease management costs private healthcare insurance
All authors gratefully acknowledge the contribution of Raimundo Gomes MSc, Bupa Australia, for extracting the data from the Bupa Australia claims database.
This trial was funded by the Bupa Health Foundation, Australia, which is an independent foundation with charity status under the Australian Taxation Office rules.
Compliance with Ethical Standards
This study was conducted in accordance with the ethics approval from the Griffith University Human Research Ethics Committe (ref MED/10/11/HREC).
Conflict of Interest
PS, JB and SN were independent consultants and have no conflicts of interest. CP and SG are employees of Bupa Australia. DC is an employee of Bupa Health Dialog, part of Bupa Australia. Coaching was provided by Bupa Health Dialog. Health Dialog in the USA provided the risk scoring algorithm which was adapted for Australia.
The funders had no role in the trial design, data analysis, interpretation of data, or writing of this report. The corresponding author had full access to the extracted data in the trial and had final responsibility for the decision to submit for publication.
- 2.Todd W, Nash D, editors. Disease Management: A Systems Approach to Improving Patient Outcomes. San Francisco: Jossey Bass, 2001.Google Scholar
- 8.AIHW. Admitted patient care 2014–15: Australian hospital statistics. Health services series no. 68. Cat. no. HSE 172. Canberra: AIHW. 2016Google Scholar
- 12.Greene W. Accounting for excess zeros and sample selection in poisson and negative binomial regression models. Working Papers EC-94-10. New York University: New York University, Leonard N. Stern School of Business, Department of Economics, 1994.Google Scholar
- 17.Williams ED, Bird D, Forbes AW, et al. Randomised controlled trial of an automated, interactive telephone intervention (TLC Diabetes) to improve type 2 diabetes management: baseline findings and six-month outcomes. BMC Public Health 2012;12:602. https://doi.org/10.1186/1471-2458-12-602 [published Online First: 2012/08/04]CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Gordon LG, Bird D, Oldenburg B, et al. A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes. Diabetes Res Clin Pract 2014;104(1):103–11. https://doi.org/10.1016/j.diabres.2013.12.032 [published Online First: 2014/02/08]CrossRefPubMedGoogle Scholar
- 20.Sangster J, Church J, Haas M, et al. A Comparison of the Cost-effectiveness of Two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease. Heart Lung Circ 2015;24(5):471–9. https://doi.org/10.1016/j.hlc.2015.01.008 [published Online First: 2015/02/24]CrossRefPubMedGoogle Scholar
- 21.Patja K, Absetz P, Auvinen A, et al. Health coaching by telephony to support self-care in chronic diseases: clinical outcomes from The TERVA randomized controlled trial. BMC Health Serv Res 2012;12:147. https://doi.org/10.1186/1472-6963-12-147 [published Online First: 2012/06/12]CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Hawkes AL, Patrao TA, Atherton J, et al. Effect of a telephone-delivered coronary heart disease secondary prevention program (proactive heart) on quality of life and health behaviours: primary outcomes of a randomised controlled trial. Int J Behav Med 2013;20(3):413–24. https://doi.org/10.1007/s12529-012-9250-5 [published Online First: 2012/09/27]CrossRefPubMedGoogle Scholar
- 23.Turkstra E, Hawkes AL, Oldenburg B, et al. Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial (ProActive Heart). BMC Cardiovasc Disord 2013;13:33. https://doi.org/10.1186/1471-2261-13-33 [published Online First: 2013/05/03]CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Blackberry ID, Furler JS, Best JD, et al. Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement and Coaching for Health (PEACH) pragmatic cluster randomised controlled trial. BMJ 2013;347:f5272. https://doi.org/10.1136/bmj.f5272 [published Online First: 2013/09/21]CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Ruggiero L, Riley BB, Hernandez R, et al. Medical assistant coaching to support diabetes self-care among low-income racial/ethnic minority populations: randomized controlled trial. West J Nurs Res 2014;36(9):1052–73. https://doi.org/10.1177/0193945914522862 [published Online First: 2014/02/27]CrossRefPubMedPubMedCentralGoogle Scholar