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On May 22, 2008, Rosanna Coffey made a presentation in a Webinar entitled The Asthma Care Return-on-Investment Calculator: How To Use It. This is the text version of the event's slide presentation. Please click here to access the PowerPoint Slides. The Asthma Care Return-on-Investment Calculator: How to use it May 22, 2008 On the top of the slide are the logos for the Department of Health & Human Services and the Agency for Healthcare Research and Quality (AHRQ). Slide 2 Outline 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.
Slide 3 Review of the Calculator Slide 4 Purpose
Slide 5 Methods The sum of Evidence of Utilization Impact and Cost Data is Financial Impact. • Definitions: Asthma care programs typically follow NAEPP (National Asthma Education and Prevention Program) guidelines
Slide 6 How to use the calculator: Data Slide 7 Data needed: Overview
Slide 8 Data needed: Eligible asthma patients Options: A. Calculate number eligible using own data (i.e. medical claims) or B. Use calculator to estimate eligible patients More details: • Calculate number eligible using own data (i.e. medical claims) • Define criteria for eligible asthma patients. Example:
• NCQA HEDIS definition: http://www.ncqa.org • See Tables 8 and 10 in detailed report Slide 9 Data needed: Eligible asthma patients • Use calculator to estimate eligible asthma patients Data Fields
• Options
• How calculator estimates eligible patients:
Slide 10 Data needed: Baseline Baseline = the use and cost patterns of program participants before the asthma care program Data Fields Use
Cost (payment amount)
Slide 11 Data needed: Baseline Data Fields (continued) Missed work or school (optional)
Advice for calculating data fields:
Slide 12 Data needed: Baseline Source of default data: MarketScan Claims Database (2005) • Medicaid
• Employer-sponsored health insurance
National Health Interview Survey (2003)
Bureau of Labor Statistics (2006)
Slide 13 Data needed: Evidence Data Fields Average annual percent change in:
Where to find these data:
Slide 14 Data needed: Evidence Example calculation of percent change in visits The chart below indicates that the Rate at baseline (Before) for the Treatment Group is 10 (A) and the Rate at the end (After) is 5 (B). The Rate at baseline (Before) for the Control Group is 10 (C) and the Rate at the end (After) is 8 (B)
Percent change in treatment - percent change in control = (B-A)/A*100 – (D-C)/C*100 = - 50 - (- 20) = - 30% Slide 15 Data needed: Evidence in calculator ED visits Children only: 13,213 Total patients and 21 Number of studies Adults only: 714 Total patients and 11 Number of studies Both children and adults: 8,812 Total patients and 9 Number of studies TOTAL: 22,739 Total patients and 40 Number of studies Hospitalizations Children only: 17,575 Total patients and 19 Number of studies Adults only: 7,161 Total patients and 9 Number of studies Both children and adults: 2,526 Total patients and 7 Number of studies TOTAL: 27,262 Total patients and 33 Number of studies Outpatient visits Children only: 20,229 Total patients and 18 Number of studies Adults only: 6,986 Total patients and 4 Number of studies Both children and adults: 1,888 Total patients and 5 Number of studies TOTAL: 29,103 Total patients and 25 Number of studies Missed work/school days Children only: 4,172 Total patients and 11 Number of studies Adults only: 521 Total patients and 5 Number of studies Both children and adults: 443 Total patients and 3 Number of studies TOTAL: 5,136 Total patients and 17 Number of studies Medication Cost Children only: 486 Total patients and 2 Number of studies Adults only: 301 Total patients and 3 Number of studies Both children and adults: 13,580 Total patients and 5 Number of studies TOTAL: 14,367 Total patients and 10 Number of studies Ancillary service cost Children only: 61 Total patients and 1 Number of studies Adults only: 148 Total patients and 2 Number of studies Both children and adults: 0 Total patients and 0 Number of studies TOTAL: 209 Total patients and 3 Number of studies Notes: Total studies can be less than the sum of the columns because some studies reported results separately for adults and children Total patients includes both treatment and control patients Slide 16 Data needed: Program cost and design Data fields
Questions to consider
Slide 17 Data needed: Wrap-up • Types of data needed
• Putting it all together
• Use claims data to obtain number of eligible asthma patients and their baseline utilization and costs • Find evidence that studied a similar population Slide 18 Data needed: Discussion • Ideas for data sources?
• What technical assistance do you need from AHRQ to find data? • Questions? Slide 19 How to use the calculator Interpretation of results Slide 20 Example results • Results from default data
Slide 21 Results using default data Not all options are shown Option (1) Type of Insurance: Medicaid Age Groups: Adults and children Asthma Severity: Persistent asthma Annual Program Cost: $395 Medical costs included: All payments Productivity costs included: No Number of eligible patients with asthma (nationwide): 1.97 million Results Net Present value (per participant): ($1,552) ROI: $0.14 Break Even Program Cost: $56.04 Option (2) Type of Insurance: Medicaid Age Groups: Children Asthma Severity: Persistent asthma Annual Program Cost: $395 Medical costs included: All payments Productivity costs included: No Number of eligible patients with asthma (nationwide): 850 thousand Results Net Present value (per participant): ($1,228) ROI: $0.32 Break Even Program Cost: $126.76 Option (3) Type of Insurance: Medicaid Age Groups: Children Asthma Severity: Persistent asthma Annual Program Cost: $100 Medical costs included: All payments Productivity costs included: No Number of eligible patients with asthma (nationwide): 850 thousand Results Net Present value (per participant): $123 ROI: $1.27 Break Even Program Cost: $126.76 Option (4) Type of Insurance: Employer sponsored Age Groups: Children Asthma Severity: Persistent asthma Annual Program Cost: $100 Medical costs included: All payments Productivity costs included: No Number of eligible patients with asthma (nationwide): 1 million Results Net Present value (per participant): ($60) ROI: $0.87 Break Even Program Cost: $66.97 Slide 22 Results using default data Option (5) Type of Insurance: Employer sponsored Age Groups: Children Asthma Severity: Persistent asthma with acute visits Annual Program Cost: $100 Medical costs included: All payments Productivity costs included: No Number of eligible patients with asthma (nationwide): 200 thousand Results Net Present value (per participant): $822 ROI: $2.80 Break Even Program Cost: $279.54 Option (6) Type of Insurance: Employer sponsored Age Groups: Children Asthma Severity: Persistent asthma with acute visits Annual Program Cost: $100 Medical costs included: Only plan costs Productivity costs included: No Number of eligible patients with asthma (nationwide): 200 thousand Results Net Present value (per participant): $561 ROI: $2.22 Break Even Program Cost: $222.39 Option (7) Type of Insurance: Employer sponsored Age Groups: Adults Asthma Severity: Persistent asthma Annual Program Cost: $100 Medical costs included: Only plan costs Productivity costs included: No Number of eligible patients with asthma (nationwide): 2.2 million Results Net Present value (per participant): ($812) ROI: ($0.77) Break Even Program Cost: ($77.30) Option (8) Type of Insurance: Employer sponsored Age Groups: Adults Asthma Severity: Persistent asthma Annual Program Cost: $100 Medical costs included: Only plan costs Productivity costs included: Yes Number of eligible patients with asthma (nationwide): 2.2 million Results Net Present value (per participant): $2,264 ROI: $5.94 Break Even Program Cost: $594.44 Slide 23 How to use calculator • Forecast financial impact • Assess impact of key assumptions about proposed program
• Estimate “cost hurdle” needed to break-even • Negotiate with vendors • Observe components of calculator in planning an evaluation of an asthma care program Slide 24 Uses: How it helps with policy
At the bottom of the slide is an arrow pointing from graphics of literature toward money. Slide 25 Limitations and possible solutions Slide 26 Caveats
Slide 27 Caveats & Solutions Problems:
Solutions for users:
Slide 28 Discussion
Slide 29 Additional assistance: Technical Assistance: Copy of calculator or questions about the tool: For more information about AHRQ Quality Tools:
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