Use of an Integrated Health Data Warehouse to Measure the Employer Costs of Five Chronic Disease States

Health data warehouses are being developed to integrate a wide variety of databases including personnel and medical claims (inpatient, outpatient, and pharmacy), disability, absenteeism, and health-risk appraisals. This exciting technology can be very helpful in the design, implementation, and evaluation of disease management programs. First Chicago NBD installed an integrated health data management computer system or data warehouse in 1987, linking direct and indirect costs relating to health and disability. While employers have traditionally focused on direct, out-of-pocket health-care costs, indirect costs related to decreased productivity such as absenteeism have gone largely unmeasured and unmanaged. We conducted a 3-year database analysis of the direct and indirect costs associated with five common chronic diseases: diabetes mellitus, hypertension, depression, asthma, and ulcers. Of all the diseases studied in the First Chicago NBD employee population, depression, for example, results in the highest direct and indirect costs. Based on this information, First Chicago initiated a depression disease management program in 1994, which decreased per-employee medical costs from $71 per covered employee in 1993 to $61 per covered employee in 1995. During this period of time, inpatient costs for depression significantly declined, while outpatient costs increased and pharmacy benefit costs increased fourfold. Overall, medical plan costs for depression, hypertension, ulcer, asthma, and diabetes were $213, $71, $70, $48 and $35 paid per covered employee/retiree, respectively. This study of five relatively common diseases demonstrates that there are significant differences in the patterns of direct and indirect cost by disease state. It also demonstrates how data warehouses can enhance an organization's ability to measure disease state costs to assist in the implementation and evaluation of disease management strategies.