As scientific papers and reports continue to document serious gaps in the quality of care for chronically ill patients throughout the US , healthcare providers and payers have become increasingly interested in understanding how to improve care – and, how to pay for it.   Read more about cost-effectiveness and the Chronic Care Model.

Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC . Effect of improved glycemic control on health care costs and utilization. JAMA 2001; 285(2):182-9. [Link]
Sustained reductions in HbA1c of 1% or more result in cost savings within one to two years of improvement. Cost savings are highest for individuals with highest HbA1c levels at baseline. Utilization of primary care and specialty care were significantly lower among the “improved’ group, but hospitalization rates were not affected.

Goetzel RZ, Ozminkowski RJ, Villagra VG, Duffy J. Return on Investment in Disease Management: a Review. Health Care Finance Rev 2005; 26(4):1-19. [Link]
Reviewing 44 articles examining the return on investment (ROI) of disease management programs showed that some evidence suggests a positive ROI for CHF and multiple disease conditions.  Results were mixed for asthma, diabetes, and depression studies, and depended on what types of costs were included (e.g., productivity).

Gilmer T, O'connor PJ. Cost Effectiveness of Diabetes Mellitus Management Programs - a Health Plan Perspective. Disease Management & Health Outcomes 2003; 11(7):439-53. [Link N/A]
Gilmer and O’Connor propose that the elements of disease management that are cost effective include: disease management programs; clinical management; and self-management training.  Evidence is still needed to support both the costs and effectiveness of these recommendations.
Gilmer TP, O'Connor PJ, Rush WA et al. Impact of office systems and improvement strategies on costs of care for adults with diabetes. Diabetes Care 2006; 29(6):1242-8. [Link]
Organizational features and improvement strategies differentially affect future health care costs. For example, interventions focusing on the increased use of pharmaceuticals to improve care are associated with increased health care costs. Interventions that focus on clinical meetings, registries, and resource use related to diabetes or heart disease care are associated with lower costs.
Huang ES, Zhang Q, Brown SE, Drum ML, Meltzer DO, Chin MH.  The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.  Health Serv Res. 2007 Dec;42(6 Pt 1):2174-93; discussion 2294-323. [Link]

Recent study by investigators from the University of Chicago comparing the costs of implementing the Chronic Care Model to the benefits of improved health outcomes in patients.
Bibliography Editor

Katie Coleman, M.S.P.H.

Katie Coleman is a research associate with the MacColl Institute and the most recent addition to the ICIC team.  Prior to joining ICIC, she managed a portfolio of government grants for the nation’s largest network of community health centers.  Her research interests include healthcare financing, pay for performance, and access to care including Medicaid and FQHC policy.