Impact of population-based disease management services (encompassing population analytics and telephone health coaching) on cost and hospitalisation for privately insured Australians with selected chronic conditions

INTERVENTION: Disease management services from Bupa Health Dialog including mailed program awareness notifications, tailored mailed educational material, tailored outreach material designed to encourage individuals with specific risks to talk with a Health Coach, outbound Health Coach outreach and follow‐up calls (a minimum of two calls in first two months with no maximum number of calls being set), access on an inbound telephonic basis to Health Coaches, and mailed Health Coach selected educational and other material. Duration of the intervention is for 12 months. CONDITION: Hospital, medical and prostheses costs borne by private insurers. PRIMARY OUTCOME: The primary outcome measure is the total (non‐maternity) cost for health fund members. Cost in this study is measured from the perspective of a private health insurer. That being, the total benefit paid calculated as the summation of hospital, medical (excluding Medicare component) and prostheses. Ancillary benefits will not be included as the role of the intervention in impacting on a range of benefits including dental and optical is not sufficiently well defined. SECONDARY OUTCOME: Costs (non‐maternity) per member in the intervention year by type of service. Rates of inpatient (non‐maternity) hospitalisations in total in the intervention year. Outcome is assessed based on data linkage to private insurance claims. Rates of non‐maternity inpatient bed days in the intervention year. Outcome is assessed based on data linkage to private insurance claims. Same day non‐ maternity admission rates in the intervention year. Outcome is assessed based on data linkage to private insurance claims. INCLUSION CRITERIA: Hold hospital cover with Bupa Australia (and have done so for at least 12 months continuously immediately prior to recruitment); Have claims evidence of diagnosis of low back pain, diabetes, coronary artery disease, congestive heart failure, or chronic obstructive pulmonary disease; Are the highest risk member of their household based on predicted risk; and Have claims‐based predicted risk level above a pre‐determined threshold of 0.061. This is equivalent to a predicted cost for the following 12 months of $3,050 or more.