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Can Disease Management Target Patients Most Likely to Generate High Costs? The Impact of Comorbidity

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Abstract

Context

Disease management programs are increasingly used to manage costs of patients with chronic disease.

Objective

We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs.

Design

Retrospective analysis of prospectively obtained data.

Setting

A general medicine practice with both faculty and residents at an urban academic medical center.

Participants

Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year.

Main Outcomes

Annual cost of diseases targeted by disease management.

Measurements

Patients’ clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs.

Results

Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs.

Conclusions

Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care.

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Conflict of Interest

None disclose

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Executive Director, Center for Complementary and Integrative Medicine, Weill Medical College of Cornell University, 525 East 68th Street, Box 46, New York, NY, 10021, USA

    Mary Charlson MD, William Briggs PhD & James Hollenberg MD

  2. Yale New Haven Hospital, New Haven, CT, USA

    Robert E. Charlson MD

Authors
  1. Mary Charlson MD
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  2. Robert E. Charlson MD
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  3. William Briggs PhD
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  4. James Hollenberg MD
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Corresponding author

Correspondence to Mary Charlson MD.

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Charlson, M., Charlson, R.E., Briggs, W. et al. Can Disease Management Target Patients Most Likely to Generate High Costs? The Impact of Comorbidity. J GEN INTERN MED 22, 464–469 (2007). https://doi.org/10.1007/s11606-007-0130-7

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  • DOI: https://doi.org/10.1007/s11606-007-0130-7

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