The Missouri project brought together a group of 14 hospitals and 168 physician offices that helped patients with diabetes better manage their disease by giving them the knowledge, confidence and skills required for self-management. Health care providers also worked with community organizations to develop supportive programs, activities and opportunities for diabetes education.

"The health care community is at a crossroads," said Richard A. Royer, Chief Executive Officer for Primaris. "Meeting the needs of chronically ill patients is becoming more difficult and more expensive. This group showed patients the importance of self-management, and taught them how to monitor and take control of their disease."

Studies touting the benefits of better disease management have been documented in several medical journals. A recently developed disease management pilot in Florida, for example, saved the state's Medicaid system an estimated $42 million in its first two years.

Experts estimate that 80 cents of every health care dollar are spent treating those with chronic illnesses like diabetes, heart disease, asthma and arthritis.

"The challenge ahead requires that we produce the best outcomes for patients in the most cost-effective fashion possible," said Julie Eckstein, Director of DHSS. "That's a huge challenge inside our current system of care, but the model project Missouri has implemented shows us we can succeed."

Eckstein also said she encourages patients with chronic illnesses to discuss their disease with their physician, and to take an active role in their medical care. Disease management successes also rely on increasing linkages between health care and community resources available to support positive outcomes for individuals with chronic diseases.

"In order to improve, patients, physicians and other community groups need to work together," she said.

Summary of Improvements:

• The percentage of patients with appropriate blood sugar levels increased by almost 60 percent, as measured using " Hemoglobin A1c" tests. This test helps doctors estimate how much sugar was in a patient's blood during the previous six months. Experts have estimated that patients who maintain near-normal blood sugar levels live much longer, more productive lives.


• Patients' LDL ("bad") cholesterol levels dropped nearly 7 percentage points. Higher levels of LDL cholesterol put a person at risk for heart disease, the nation's number one killer.


• More than 1,200 patients overdue for a retinal eye exam were referred to an eye specialist, representing an improvement of almost 16 percent. Screening of and treatment for diabetes- related eye diseases annually saves an estimated 54,000 years of sight. Each year gained represents an estimated cost savings of more than $2,000.


• Seven percent of patients quit smoking. A study by the Centers for Disease Control and Prevention suggested that smoking causes 440,000 premature deaths each year and costs $157 billion in annual health-related economic losses.