Rising out-of-pocket costs in disease management programs

objectives: To document the rise in copayments for patients in disease management programs and to call attention to the inherent conflicts that exist between these 2 approaches to benefit design.

Methods: Data from 2 large health plans were used to compare cost sharing in disease management programs with cost sharing outside of disease management programs.

Results: The copayments charged to participants in disease management programs usually do not differ substantially from those charged to other beneficiaries.

Conclusions: Cost sharing and disease management result in conflicting approaches to benefit design. Increasing copayments may lead to underuse of recommended services, thereby decreasing the clinical effectiveness and increasing the overall costs of disease management programs. Policyrnakers and private purchasers should consider the use of targeted benefit designs when implementing disease management programs or redesigning cost-sharing provisions. Current information systems and health services research are sufficiently advanced to permit these benefit designs.