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 1

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 2

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 3

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 4

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 5

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 6

How does the calculator work?

•  72,777 participants who average, 0.25 ED visits per year à 18,194 annual visits to ER

•  Asthma program and an arrow pointing downwards next to 30% à 5,458 visits to ER saved

•  Each visit costs $88 à $480,304 saved

Repeat for each component asthma-related costs

Compare change in medical care expenditures with program cost

Slide 7

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 8

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 9

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 10

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

Underneath the text is a large yellow arrow pointing to the following text: Use calculator in planning an asthma care program; Framework of calculator may be useful for evaluating an asthma care program.

Slide 11

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 12

Population

This slide contains a screen shot of the Population page from AHRQ's Asthma Care ROI calculator. Users are prompted to select the type and geography of the general population (people with and without asthma).

Slide 13

Participants

This slide contains a screen shot of the Participants page from AHRQ's Asthma Care ROI calculator. The screen prompts the user to select the age group and asthma severity to target for a quality improvement program. Next, the user is to review the number of people eligible for the program and the percent expected to participate in the program.

Slide 14

Baseline Data

This slide contains a screen shot of the Baseline Data page from AHRQ's Asthma Care ROI calculator. Two decisions must be made on the page in order to use: 1) Select a treatment definition and cost perspective for calculating results, and 2) Review the baseline utilization and cost estimates.

Slide 15

Program Impact

This slide contains a screen shot of the Program Impact page from AHRQ's Asthma Care ROI calculator. The page shows the impact estimates from a meta-analysis of the research literature on asthma quality improvement and disease management. Both healthcare measures, such as program impact on emergency department visits, and productivity measures, such as program impact on missed work days per adult, can be assessed using this tool.

Slide 16

Program Cost

This slide contains a screen shot of the Program Cost page from AHRQ's Asthma Care ROI calculator. The page shows four decisions that will affect calculations of the cost of the program to be implemented:

•  Length of operation planned for the program

•  Time until the full-impact of program is expected

•  Cost of the program per person per year (consider changing based on costs estimates for a specific programs from vendors).

Discount rate for valuing savings and costs that occur in different years

Slide 17

Results

This slide contains a screen shot of the Results page from AHRQ's Asthma Care ROI calculator. The page shows the impact of the asthma program and summarizes prior assumptions made in the calculator. Two decisions must be made on this page: 1) Whether to include health care savings, productivity gains, or both. 2) Whether to report results per participant or per program.

Slide 18

Undiscounted Results per Person for the User-Specified Program Tabulated by Outcome Measure and Year

This slide contains a screen shot of the Undiscounted Results per Person for the User-Specified Program page from AHRQ's Asthma Care ROI calculator. The page shows the annual utilization and cost per patient for emergency department visits, hospital confinements, outpatient visits, emergency department cost, hospital confinement cost, outpatient cost, asthma-specific ancillary cost, asthma medication cost, missed work days for adults, missed school days for children, productivity cost for adults, and productivity cost for caregivers. The data can be calculated for years 2007 to 2012. Data for 2007 represent the baseline period before the program is implemented.

Slide 19

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 20

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 21

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 22

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
• Baseline asthma medication costs varied

Slide 23

Conclusions

What are the key drivers of ROI?

•  Decrease in costs due to hospitalizations

•  Increase in medication use

•  Cost to implement the program

Slide 24

What can the asthma care calculator do?

•  Help forecast the financial impact of asthma care programs

•  Summarizes published evidence from 52 studies on the impact of asthma care programs on use of medical care services and productivity

Slide 25

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)