In 2005 health insurance plans and employers spent $1.2 billion on disease management programs. Management programs have become a key point in the national health care reform debate as policymakers search for a way to improve health care quality and access, while at the same time controlling cost.

Disease management has become viewed as the silver bullet that can fix two problems of the health care system—inadequate quality and high costs. A recent RAND study indicates that disease management programs do improve the quality of health care, unfortunately, there is no conclusive evidence that they can actually save money and in some cases may cause an increase in health care expenses.

The RAND study analyzed 317 previous research studies on various disease management programs, focusing their attention on six chronic conditions:

1. Congestive heart failure.
2. Coronary artery disease.
3. Diabetes.
4. Asthma.
5. Depression.
6. Chronic obstructive pulmonary disease.

Researchers found most of the studies reviewed followed patients for only about a year, which is not long enough to assess long-term health outcomes. Some diseases, like cholesterol, may be effective in the short-term, but it can take years to determine whether those interventions—assuming they were sustained for a long period—can prevent heart attacks and costly hospitalizations years into the future. They found consistent evidence that these programs improve health care quality, improve disease control, and, in the case of patients with congestive heart failure, reduce hospital admission rates.

Patients with depression who were enrolled in disease management programs were more likely to use outpatient care and prescription drugs, which increased cost. Also, there is little evidence about whether these programs improve health outcomes over the long term.

The study suggest that disease management programs reduce costs for congestive heart failure patients because many programs reduce hospital admissions. In contrast, research indicates that patients with depression are commonly under-treated, so a disease management program that actively screens for depression and encourages patients to get treatment increases costs.

Researchers recommend that insurance plans, employers, and policymakers will have to evaluate whether the benefits of disease management programs are worthwhile, despite the lack of evidence for cost-savings. Just because one type of intervention can benefit one disease doesn’t mean it will work the same way for another disease.