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Impact of a Managed-Medicare Physical Activity Benefit on Health Care Utilization and Costs in Older Adults With Diabetes

¹ Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
² Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
³ Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire
⁴ Department of Health Services, University of Washington, Seattle, Washington
⁵ Health Promotion Research Center, University of Washington, Seattle, Washington
⁶ Center for Health Studies, Group Health Cooperative, Seattle, Washington
⁷ Center for Health Services Research in Primary Care, Durham VA Medical Center and Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Durham, North Carolina
⁸ Department of Medicine, Department of Health Services, and Health Promotion Research Center, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Huong Q. Nguyen, PhD, University of Washington, HSB T602A, Box 357266, Seattle, WA 98199. E-mail: hqn{at}u.washington.edu

OBJECTIVE—The purpose of this article was to determine the effects of a managed-Medicare physical activity benefit on health care utilization and costs among older adults with diabetes.

RESEARCH DESIGN AND METHODS—This retrospective cohort study used administrative and claims data for 527 patients from a diabetes registry of a staff model HMO. Participants (n = 163) were enrolled in the HMO for at least 1 year before joining the Enhanced Fitness Program (EFP), a community-based physical activity program for which the HMO pays for each EFP class attended. Control subjects were matched to participants according to the index date of EFP enrollment (n = 364). Multivariate regression models were used to determine 12-month postindex differences in health care use and costs between participants and control subjects while adjusting for age, sex, chronic disease burden, EFP attendance, prevention score, heart registry, and respective baseline use and costs.

RESULTS—Participants and control subjects were similar at baseline with respect to age (75 ± 5.5 years), A1C levels (7.4 ± 1.4%), chronic disease burden, prevention score, and health care use and costs. After exposure to the program, there was a trend toward lower hospital admissions in EFP participants compared with control subjects (13.5 vs. 20.9%, P = 0.08), whereas total health care costs were not different (P = 0.39). EFP participants who attended 1 exercise session/week on average had 41% less total health care costs compared with those attending <1 session/week (P = 0.03) and with control subjects (P = 0.02).

CONCLUSIONS—Although elective participation in a community-based physical activity benefit at any level was not associated with lower inpatient or total health care costs, greater participation in the program may lower health care costs. These findings warrant additional investigations to determine whether policies to offer and promote a community-based physical activity benefit in older adults with diabetes can reduce health care costs.

Abbreviations: EFP, Enhanced Fitness Program • GHC, Group Health Cooperative of Puget Sound

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