VOL. 15, NO. 2 n THE AMERICAN JOURNAL OF MANAGED CARE n฀ 113 n MANAGERIAL n © Managed Care & Healthcare Communications, LLC A s major purchasers of healthcare in the United States, em- ployers are increasingly using population health management programs to constrain the growth of healthcare costs. Accord- ing to a recent survey, 65% of employers with 500 or more employees and 75% of those with 20,000 or more employees provided 1 or more disease management programs in 2006, up from 58% in 2004. 1 Popula- tion health management programs combine interventions that focus on patients with specific chronic conditions (disease management) or very high cost irrespective of the cause (case management) with so- called wellness components that are aimed at using health risk assess- ments (HRAs) to identify unhealthy behaviors (eg, smoking, lack of exercise) or risk factors (eg, elevated blood pressure) and at helping employees and dependents address these health risks in order to pre- vent the development of chronic diseases. 2,3 Although integrated population health management is conceptually appealing, there is limited scientific evidence that it can actually deliver on its promises. This is in part because evaluations are typically conduct- ed by the program vendors themselves using proprietary methods and are not submitted to peer-reviewed journals. Those methods are typically based on observational designs and thus prone to bias. 4 As the industry is increasingly aware that skepticism about the impact of these programs impedes market growth, more rigorous and transparent evaluation stan- dards are beginning to emerge. Most notably, the Disease Management Association of America (DMAA) has published national consensus recommendations for disease management evaluation. 5,6 Although these guidelines represent an important step toward transparency, they have 2 major limitations. First, although use of an equivalent compari- son group is encouraged, the guidelines do not explicitly recommend individual-level statistical analysis to account for differences between intervention and comparison groups. 7 Second, they are specifically de- signed for stand-alone disease management programs, whereas many employers are now implementing and attempting to measure integrated programs across the care continuum. We used data from the population health management programs of 2 large employers to analyze the impact of the program on overall medical cost and on utilization of in- patient and emergency department (ED) care. We conducted sensitivity analyses to assess the impact of meth- odologic choices on our findings. To In this issue Take-Away Points / p119 www.ajmc.com Full text and PDF Impact of 2 Employer-Sponsored Population Health Management Programs on Medical Care Cost and Utilization Soeren Mattke, MD, DSc; Seth A. Serxner, PhD, MPH; Sarah L. Zakowski, BA; Arvind K. Jain, MS; and Daniel B. Gold, PhD Background: Integrated health management pro- grams combining disease prevention and disease management services, although popular with employers, have been insufficiently researched with respect to their effect on costs. Objective: To estimate the overall impact of a population health management program and its components on cost and utilization. Study Design, Setting, and Participants: Obser- vational study of 2 employer-sponsored health management programs involving more than 200,000 health plan members. Methods: We used claims data for the first pro- gram year and the 2 preceding years to calculate cost and utilization metrics, and program activity data to determine program uptake. Using an intent-to-treat approach and regression-based risk adjustment, we estimated whether the program was associated with changes in cost and utiliza- tion. Data on program fees were unavailable. Results: Overall, the program was associated with a nonsignificant cost increase of $13.75 per mem- ber per month (PMPM). The wellness component alone was associated with a significant increase of $20.14 PMPM. Case and disease management were associated with a significant decrease in hospital admissions of 4 and 1 per 1000 patient- years, respectively. Conclusions: Our results suggest that the pro- grams did not reduce medical cost in their first year, despite a beneficial effect on hospital admis- sions. If we had been able to include program fees, it is likely that the overall cost would have increased significantly. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed. (Am J Manag Care. 2009;15(2):113-120) For author information and disclosures, see end of text.