A government think tank is questioning whether programs that try to improve care for patients with diabetes and other chronic conditions have shown that they can pay for themselves.[@@]

The Congressional Budget Office, an arm of Congress, studied the issue for Sen. Don Nickles, R-Okla., chairman of the Senate Budget Committee, and other members of the House and Senate budget committees.

Nickles had asked the CBO what the programs could do to cut costs for Medicare beneficiaries and other patients.

Many employers, health insurers and benefits consultants are counting on expanded disease management programs to help control the United States’ skyrocketing medical costs.

“It is important to note that such programs could be worthwhile even if they did not reduce costs,” Douglas Holtz-Eakin, the CBO director, writes in a letter to Nickles.

For now, though, Holtz-Eakin writes, “there is insufficient evidence to conclude that disease management programs can generally reduce overall spending.”

Many of the studies that attempt to address the effects of disease management programs focus on intermediate measures, such as reductions in the number of return hospital visits, rather than effects on actual costs, Holtz-Eakin adds.

But Holtz-Eakin writes that even the studies that directly look at costs are flawed because they fail to deal with the effects of disease management programs on randomly selected groups of patients.

In the area of diabetes management, for example, “one widely cited study reports lower costs and utilization for patients enrolled in a disease management program at [a health maintenance organization]: $395 per member per month in average paid claims for patients in the program compared with $502 for other patients,” Holtz-Eakin writes. “

But the results of the program may have been biased because participation in the program was optional and the reported savings failed to include the cost of the disease management program, Holtz-Eakin argues.

Another study found that controlling HbA1c levels, an indicator of long-term blood sugar control, can save $685 to $950 per patient per year, but “patients who saw improvements in their HbA1c levels probably differed from other patients who did not in many other ways that would affect their health costs, so the reported results may have little to do with the effects of disease management,” Holtz-Eakin concludes.