On the top of the slide are the logos for the Department of Health & Human Services and the AHRQ logo. The Department of Health & Human Services logo is an artistic image of an eagle with the outlined profile of faces. The AHRQ logo reads, “AHRQ – Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, www.ahrq.gov”.

Slide 2

Agenda

This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left. The header and body of the slide are separated by a light blue horizontal line that traverses 80 percent of the slide from the left.

• What is the Asthma Care Return-on-Investment calculator?
• Background
  • Definitions
  • Key issues
  • How can the calculator help evaluate asthma care programs? What does it provide?
• How does the calculator work?
• Features of the calculator
• Summary of literature review
• Conclusions
• Resources

Slide 3

What is the Asthma Care ROI Calculator?

• Purpose
  • Help state policy makers and health plans estimate financial returns asthma quality improvement programs
• Why developed?
  • Most studies don't address financial impact, rather clinical and use impacts only
  • Clinical or use impacts need to be translated into costs or savings
• How are estimates generated?
  • Combine clinical evidence about impacts on utilization with separate cost data to estimate financial impact

Slide 4

Background: definitions

• Asthma care programs typically follow NAEPP (National Asthma Education and Prevention Program) guidelines
  • Patient education
  • Provider activities
• Financial metrics

Return on Investment (ROI) = Savings/Program Cost= $1 break even

Net Present Value (NPV) = Savings-Program Cost= $0 break even

Slide 5

Background: cost vs. quality

• Programs that improve quality of asthma care may or may not reduce total medical care costs

Beneath the text is a visual equation with graphics. From left to right, there is a hospital, an arrow pointing downwards, a plus sign, prescription medicine, an arrow pointing up, an equal sign, and a question mark.

Slide 6

Background: program evaluation methods

• Regression to the mean bias
  • Sick patients may get better over time, even without the program
  • To be successful, a program must “beat” the regression to the mean bias

Beneath the text are two groups of graphics which represent program cohort with a yellow arrow pointing down next to 60%, and control cohort with a yellow arrow pointing down next to 20%. Both graphics are included in a bracket labeled “True effect of program,” an equal sign, and graphics of a hospital, a yellow arrow pointing down, and 40%.

Slide 7

How does the calculator work?

• 72,777 participants who average, 0.25 ED visits per year - 18,194 annual visits to ER
• Asthma program and an arrow pointing downwards next to 30% - 5,458 visits to ER saved
• Each visit costs $88 - $480,304 saved

Repeat for each component asthma-related costs

Compare change in medical care expenditures with program cost

Slide 8

How does the calculator work?

Cost components

• Asthma-related medical care
  • Emergency department visits
  • Hospital stays
  • Outpatient visits
  • Medications
  • Ancillary testing
• Productivity
  • Missed school or work days

Slide 9

Data sources

• Population demographics
  • Medicaid (CMS 2003)
  • Employer sponsored health insurance (CPS 2003-2005)
• State employees (BLS 2003-2005)
• Large, nationwide, medical claims database (MarketScan TM)
  • Prevalence rates
  • Utilization and costs for asthma patients
• Literature review (52 studies)
• Impact of asthma care programs
• Cost to implement asthma care programs
• You!
  • Virtually all data used by the model can be changed by the user

Slide 10

Calculator features

• Ability to examine how the following factors may change financial impact of program
• Who is included in the program
  • Children, adults, or both
  • All asthma patients, or only those with persistent asthma
  • Medicaid, employer-sponsored insurance, or state employees
• What benefits are counted?
• Only medical care savings or also include productivity gains?
  • Length of the program
  • Cost to implement the program
  • Options to describe benefits and costs from a third-party payer or society perspective.

Slide 11

Calculator features

• Ability to choose the research design to use in estimating savings
  • Studies without a control group
• Use as a benchmark for preliminary results
  • Studies with a control group
• Shows expected true savings
• Comparisons between study designs can be used to assess magnitude of regression to the mean bias

Underneath the text is a large yellow arrow pointing to the following text: Use calculator in planning, monitoring and/or evaluative phases of an asthma care program.

Slide 12

Steps in the ROI calculator

This slide shows a series of steps in the ROI calculator. The steps include:

1. Describe population
2. Estimate number of participants
3. Estimate baseline utilization or missed work days
4. Estimate impact of the asthma program
5. Estimate program cost

ROI

User choices about the asthma program are the user data that is used in at all five steps. Meta-analysis occurs at steps 4 and 5.

Slide 13

Results from the literature review

Savings more likely for some populations than others, depending on the component of care. For example:

Interventions on people with persistent asthma (versus all asthma) had:

• Higher savings on ED visits and outpatient visits
• Similar savings on missed work/school days
• Lower savings on hospitalizations
• Smaller increases in medication costs (so higher savings)

Slide 14

Results from the literature review

Interventions on Medicaid populations (versus other coverage) had:

• Higher savings on hospitalizations, outpatient visits, missed work/school days
• Lower savings on ED visits

Interventions on children (versus adults) had:

• Higher savings on outpatient visits and asthma medications
• Lower savings on ED visits, hospitalizations, and missed work/school days

Controlled studies showed lower savings than non-controlled studies

Slide 15

Results from literature

Few studies reported program cost; those that did reported a wide range (7 studies)

• Average of $395 dollars per patient per year
• Low of $81 for automated educational mailing to general populations
• High of $989 per year, targeted to highest cost patients

Slide 16

Results from literature

Few studies reported the impact on asthma medication use (10 studies)

• Studies without a control group reported larger increases in medication costs
• Studies with a control group reported smaller increases in medication costs
• Baseline asthma medication costs varied a great deal, suggesting different cost and utilization settings
• Recent increase in use of drug formularies and availability of generics may result in lower increases in medication cost than reported by some of the older studies included in our review

Slide 17

Conclusions

What kinds of programs are more likely to find savings?

Programs that…

• Target patients who use the emergency department and hospital for asthma care
• Target children
• Target Medicaid program

Slide 18

Conclusions

What are the key drivers of ROI?

• Decrease in costs due to hospitalizations
• Increase in medication use
• Cost to implement the program

Slide 19

Conclusions

What can the asthma care calculator do?

• Help plan, monitor and evaluate financial impact of asthma care programs
• Summarizes published evidence on financial impact of asthma care programs

Slide 20

Resources

• Breakout sessions
  • Policy implications
  • Hands-on-Training
• Handouts
  • Screen shots example
• Detailed report available on request
  • Documents methods, definitions used for the default baseline data
  • List of studies included in the literature review
• Send questions, suggestions and stories about the use of the calculator to:

Ginger Carls (Ginger.Carls@thomson.com) or Rosanna Coffey (Rosanna.Coffey@thomson.com)