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Disease Management 360o: A Scorecard Approach to Evaluating TRICARE's Programs for Asthma, Congestive Heart Failure, and Diabetes

Yang, Wenya MA, MPA*; Dall, Timothy M. MS*; Zhang, Yiduo PhD*; Hogan, Paul F. MS*; Arday, David R. MD, MPH; Gantt, Cynthia J. NC, USN, C-FNP, PhD

doi: 10.1097/MLR.0b013e3181e419c9
Original Article

Objective: To assess the effect of TRICARE's asthma, congestive heart failure, and diabetes disease management programs using a scorecard approach.

Evaluation Measures: Patient healthcare utilization, financial, clinical, and humanistic outcomes. Absolute measures were translated into effect size and incorporated into a scorecard.

Research Design: Actual outcomes for program participants were compared with outcomes predicted in the absence of disease management. The predictive equations were established from regression models based on historical control groups (n = 39,217). Z scores were calculated for the humanistic measures obtained through a mailed survey.

Data Collection Methods: Administrative records containing medical claims, patient demographics and characteristics, and program participation status were linked using an encrypted patient identifier (n = 57,489). The study time frame is 1 year prior to program inception through 2 years afterward (October 2005–September 2008). A historical control group was identified with the baseline year starting October 2003 and a 1-year follow-up period starting October 2004. A survey was administered to a subset of participants 6 months after baseline assessment (39% response rate).

Results: Within the observation window—24 months for asthma and congestive heart failure, and 15 months for the diabetes program—we observed modest reductions in hospital days and healthcare cost for all 3 programs and reductions in emergency visits for 2 programs. Most clinical outcomes moved in the direction anticipated.

Conclusions: The scorecard provided a useful tool to track performance of 3 regional contractors for each of 3 diseases and over time.


From the *The Lewin Group, Falls Church, VA; †Office of the Chief Medical Officer (OCMO), Population Health and Medical Management Division, TRICARE Management Activity (TMA), Falls Church, VA; and ‡US Naval Hospital Guam, Agana, GU.

Supported by the Office of the Assistant Secretary of Defense, TRICARE Management Activity, the Health Program Analysis and Evaluation Division (HPA&E), and the Office of the Chief Medical Officer (OCMO), Falls Church, VA.

The opinions or assertions herein are those of the authors and do not necessarily reflect the view of the United States Department of Defense.

The author CAPT Cynthia J. Gantt was formerly at the Office of the Chief Medical Officer, TRICARE Management Activity.

Reprints: Wenya Yang, MA, MPA, The Lewin Group, 3130 Fairview Park Dr, Suite 800, Falls Church, VA 22042. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.