Public Health Finance Roundtable American Public Health Association

Public Health Finance Roundtable American Public Health Association Annual Meeting ROI Communities of Practice November 1, 2015 Lacy Fehrenbach, Director of Programs lfehrenbach@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 Mission: AMCHP supports state maternal and child health programs and provides national leadership on issues affecting women and children Vision: AMCHP envisions a society where healthy children and healthy families live in healthy communities

The Epidemiology and Evaluation Team Caroline Stampfel Associate Director Krista Granger Jen Farfalla Program Manager Data and Assessment Program Analyst QI and Life Course

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 Cost Economic 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 Economists Scott Grosse Mac Mc. Cullough Ricardo Basurto-Davila Sheri Eisert Tools and resources Roadmap LARC Examples Trainings Communities of Practice Learning Collaboratives

AMCHP Activities to Support ROI Who can participate: Key elements: Return on Investment Community of Practice (Co. P) Anyone interested in calculating return on investment, including teams that have participated in AMCHP-sponsored ROI training - Share. Point site to post and share materials with others - Participant-driven with AMCHP support Expected outputs: - - Timeframe Increased knowledge of ROI methods Learning from peers Ongoing Return on Investment Analytic Action Learning Collaborative (ALC) – Round 2 Teams that applied to the RFA and were accepted - Monthly learning events Monthly check-in with AMCHP Peer-to-peer support with ALC teams - 1 -1 Expert consultation - Private Share. Point site - Completed ROI analysis - Communications product that suits needs of team, to include fact sheet, issue brief, white paper, or some other product 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

Michigan Intervention: 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 3 rd 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

Michigan Net 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

Kansas Intervention: Cerebral Palsy Research Foundation (CPRF) outreach seating clinics vs. Wichita clinic for Title V Children with Special Health Care Needs (CSHCN) program

Kansas Intervention: 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 ü 48% Attended both fixed location PLUS one or more outreach clinic ü 52% All needs were able to be met in the outreach clinic üAverage One-way Travel Distance § 45 miles to attend outreach clinic § 205 miles to attend Wichita

Kansas 94% of families must travel to Wichita if no outreach clinic were available Average hours of work missed by parents Average hours of school missed by students • 16 hours to attend Wichita Clinic • 7 hours to attend Wichita Clinic • 9 hours for outreach clinic visits • 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 hours Indirect 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 FL • Preventive dental services for children aged 0 -20 GA • Early identification through newborn screening for genetic disorders MA • MA Project LAUNCH MS • Breastfeeding / Baby Friendly NC • Triple P (Positive Parenting Program) for families with children aged 0 to 16

Thank you! AMCHP Economic Analysis Resources: http: //www. amchp. org/programsandtopics/dataassessment/Pages/Return-on-Investment. aspx Staff Contact: Krista Granger, MPH Program Manager, Data & Assessment (202) 266 -3057; kgranger@amchp. org