ROI Communities of PracticeNovember 1, 2015

Public Health Finance RoundtableAmerican Public Health Association Annual Meeting

Lacy Fehrenbach, Director of Programslfehrenbach@amchp.org | 202-266-3039

Who is AMCHP?

AMCHP is a national resource, partner and

advocate for state public health leaders and

others working to improve the health of women,

children, youth and families, including those with

special health care needs.

AMCHP Mission and Vision

Vision: AMCHP envisions a society where healthy children

and healthy families live in healthy communities

Mission: AMCHP supports state

maternal and child health

programs and provides

national leadership on issues

affecting women and children

Caroline StampfelAssociate Director

Krista GrangerProgram Manager

Data and Assessment

Jen FarfallaProgram Analyst

QI and Life Course

The Epidemiology and Evaluation Team

Why Economic Analysis?

Health Care Prevention/Public Health

Why is AMCHP supporting ROI analysis?

• Strong interest of foundation and government

funders

• Most health departments do not employ a health

economist

• Epidemiologists in the field are not typically trained

in economic analysis

• Epidemiology is the foundation for demonstrating

return on investment

Economic Analysis in Public Health• Cost-benefit analysis: comparison of total benefits (in monetary

terms) of an investment relative to the total costs•Expressed as a dollar value capturing net economic benefit

• Cost-effectiveness analysis: improvement investment costs

divided by effectiveness•Often expressed as estimated costs per quality adjusted life year (QALY)

• Return on investment analysis (ROI): financial gains divided by

improvement investment costs; captures net financial cost to a

single stakeholder (health department, health plan, hospital)•Expressed as return, in dollars, for every dollar invested

Notes on CostEconomic Costs – Resources used up that cannot be used

elsewhere (opportunity or resource cost)

Financial Costs – Outlays by payers

Direct – Cost of providing a service

Medical; Non-medical (education, justice, etc)

Indirect – Lost output for person affected

Mortality; Disability

Parental time cost – Direct cost by US guidelines

Intangible costs - Pain and suffering; loss of well-being

Effectiveness First: The Role of Epi

Activities to Support Economic Analyses

Connections to Health EconomistsScott GrosseMac McCulloughRicardo Basurto-DavilaSheri Eisert

Tools and resourcesRoadmapLARC Examples

TrainingsCommunities of PracticeLearning Collaboratives

AMCHP Activities to Support ROIReturn on Investment Community of Practice (CoP)

Return on Investment Analytic Action Learning Collaborative (ALC) – Round 2

Who can participate:

Anyone interested in calculating return on investment, including teams that have participated in AMCHP-sponsored ROI training

Teams that applied to the RFA and were accepted

Key elements: - SharePoint site to post and share materials with others

- Participant-driven with AMCHP support

- Monthly learning events- Monthly check-in with AMCHP - Peer-to-peer support with ALC

teams- 1-1 Expert consultation- Private SharePoint site

Expected outputs: - Increased knowledge of ROI methods

- Learning from peers

- Completed ROI analysis- Communications product that suits

needs of team, to include fact sheet, issue brief, white paper, or some other product

Timeframe Ongoing Deliverables by Feb 2016

AMCHP ALC ROI Projects – Round 1

• Michigan: Preterm Birth and Home Visiting Programs

• New Mexico: Cesarean Delivery, Low Birth Weight and Doulas

• Wyoming: Preterm Birth and Nurse Family Partnership Home Visiting Program

• Kansas: Cost-effectiveness of the Cerebral Palsy Research Foundation Seating Clinics vs. Wichita clinic for Title V Children with Special Health Care Needs (CSHCN) program

MichiganIntervention: The Maternal Infant Health Program (MIHP)

benefit for Medicaid-eligible mothers, care coordination and intervention services for mom + baby; 9 visits for each, additional visits for substance-exposed infants.

AVERAGE COST: $51,757.76 per 100 infants

Outcome: Preterm birth (<=36 weeks gestation).

AVERAGE COST: $24,612.94 per infant

Program Effectiveness: Comparing MIHP-enrolled mothers who gave birth in 2010 (registered before the 3rd trimester and had at least 3 visits) to a matched sample of mothers

Non-MIHP moms had 2.9 excess preterm per 100 births

AVERAGE COST SAVINGS: $71,733.52 per 100 infants

MichiganNet Savings to Medicaid: Preterm birth costs in the control group

(222*$24,612.94 = 5,464,072.68) minus program costs ($4,225,503) = $1,238,569

KansasIntervention: Cerebral Palsy Research Foundation (CPRF) outreach seating

clinics vs. Wichita clinic for Title V Children with Special Health Care Needs (CSHCN) program

KansasIntervention: Cerebral Palsy Research Foundation (CPRF) outreach seating

clinics vs. Wichita clinic for Title V CSHCN program

Outreach Clinics

• 100% of families satisfied or very satisfied with services received

• 100% of families reported their child’s needs were met

• 50% of families reported they incurred travel expenses to attend an outreach clinic

Wichita Clinic (fixed location)

• 73% of families very satisfied, 20% satisfied and 7% somewhat satisfied

• 100% of families who attended the Wichita clinic incurred travel expenses

48% Attended both fixed location PLUS one or more outreach clinic 52% All needs were able to be met in the outreach clinicAverage One-way Travel Distance

45 miles to attend outreach clinic 205 miles to attend Wichita

Kansas94% of families must travel to Wichita if no outreach clinic were available

Average hours of work missed by parents

• 16 hours to attend Wichita Clinic

• 9 hours for outreach clinic visits

Average hours of school missed by students

• 7 hours to attend Wichita Clinic

• 4 hours to attend an outreach clinic

Cost benefit to the CSHCN program = $951 per outreach clinic

Cost savings to families attending an outreach clinic vs. the Wichita clinic = $230 in direct cost plus 8 hours work and 3

school hoursIndirect cost of lost earnings of approximately $130 per trip to

Wichita relative to an outreach visit

Kansas

Challenges• Making time to practice a new skill

• Turnover of health department staff

• Availability of cost data and comparison groups

Round 2 ALC ROI Projects

•Preventive dental services for children aged 0-20

FL

•Early identification through newborn screening for genetic disorders

GA•M

A Project LAUNCH

MA

•Breastfeeding / Baby Friendly

MS

•Triple P (Positive Parenting Program) for families with children aged 0 to 16

NC

Thank you!AMCHP Economic Analysis Resources:

http://www.amchp.org/programsandtopics/data-assessment/Pages/Return-on-Investment.aspx

Staff Contact:

Krista Granger, MPH

Program Manager, Data & Assessment

(202) 266-3057; kgranger@amchp.org