The business case for addressing disparities in asthma

十多年来，波士顿儿童医院的社区哮喘倡议（CAI）一直在改善哮喘儿童的健康和生活质量欧宝彩票平台 - 现在有关于这样做的经济利益的令人兴奋的新证据。

CAI致力于通过社区卫生工作者提供的案例管理和家庭访问来解决来自大多数低收入有色人种的儿童的哮喘的高度高率。多年来，研究表明，诸如CAI之类的二级预防计划为哮喘儿童带来更好的结果。

现在，第一次有一个商业案例 - 使用实际的保险索赔数据，这表明CAI产生了积极的投资回报。波士顿儿童研究人员进行的成本分析表明，三年后，CAI实际上节省了资金。这项研究，最近发表在Journal of Asthma, makes the business case for CAI, by capturing all costs associated with asthma that an insurer would incur such as cost of diagnoses, treatments, procedures and prescription medicines, as well as clinical care (inpatient hospitalizations, emergency department visits, primary care visits, and specialist consults).

“我们能够查看哮喘的总成本非常令人兴奋。”Dr. Elizabeth R. Woods, director of the CAI and associate chief of the Division of Adolescent/Young Adult Medicine at Boston Children’s.“This allowed us to see that CAIsaves不仅仅是成本。”

我的历史mproving health

Since its launch in 2005, CAI has provided case management to 2,132 patients. The patients are identified when they visit the Emergency Department, hospitalized for uncontrolled asthma, or referred from their primary care providers.

“It’s incredibly scary when a child can’t breathe,” says Woods. “It’s also an important teachable moment.”

Once the family enrolls in CAI, a community health worker visits them at their home and completes three visits, followed by phone calls and additional visits, as needed, at 6 months and 12 months. The community health worker helps families to improve their understanding of asthma and adherence to asthma control medications, reduce exposure to known asthma triggers in homes (such as pests, dust and mold), and provides support and case management.

A different kind of data

Previous studies have also shown cost-savings and a positive return on investment for programs like CAI. However, most of these studies relied on estimated costs, rather than actual insurance claims data, which can be difficult to obtain.

Researchers at Boston Children’s conducted the cost analyses using actual claims data from a Medicaid Managed Care Organization (MCO) in Massachusetts that included all asthma-related utilization costs between January 1, 2011 and December 31, 2016. The data was used to determine cost reductions at the following intervals: one year prior to intervention with the CAI and one, two, and three years post-intervention. The cost reduction refers to how much lower total asthma treatment costs were than those of a similar comparison group.

The analyses involved 45 patients enrolled in the CAI program and 45 from a cost-matched comparison population of patients with similar demographics who had visited Boston Children’s for asthma but were not enrolled in the CAI.

哮喘是波士顿儿童接纳的儿童最常见的诊断。这些孩子中的大多数生活在主要低收入的颜色街区。

The return on investment (ROI) was calculated as the difference in cost reduction for CAI patients and a cost-matched comparison population divided by CAI program cost. The adjusted ROIs were 0.31, 0.78, and 1.37 after 1, 2, and 3 years post-CAI intervention.

When ROI reaches 1.0, it indicates the break-even point where costs equal savings. When ROI is greater than one, it means that savings are greater than costs (a program is saving money). ROI is important because it helps businesses and organizations take the guesswork out of investing in a program (like the CAI). It shows that an organization can recover the cost of making an investment — and when that investment will become profitable.

影响保险公司

These new cost analyses show that health insurers and Accountable Care Organizations (ACOs) can recover the cost of programs like the CAI within three years. The cost reduction trend suggests that benefits may continue past three years — resulting in even larger net benefits. The findings support the business case for programs like CAI to be covered by insurance or integrated into ACOs.

“You have to be able to talk about the business case to insurers,” says Woods, who has been involved with CAI since it began.

CAI首次获得了波士顿儿童医疗补助ACO的资金。伍兹解释说，CAI团队的核心临床费用中约有一半被ACO覆盖，这反映了这样一个事实，即在CAI紧随其后的患者中，大约一半的患者在儿童医院接受了初级保健。

CAI临床总监Susan Sommer说：“ CAI计划与ACO努力提供优质的医疗保健并通过保持儿童健康来遏制成本的努力非常吻合。”“我们正在进行人口管理，专注于高风险的孩子及其健康的社会决定因素，然后运用其他资源使这些孩子离开医院 - 从长远来看，我们最终会节省金钱。”

健康决定因素的未来

医疗保健提供者和付款人越来越多地认识到社会决定因素（影响某人健康的问题，例如贫困或住房问题）在患者的健康和健康上的作用。

Programs that address these issues seldom get insurance reimbursement under traditional fee-for-service payment models. Instead, the programs often rely primarily on grants or other types of short-term funding that are unsustainable long-term.

However, this could change in the future.

“随着医疗保健融资的重点从支付费用转向替代付款模式，这些模式通过护理协调和公共卫生干预措施来激励措施减少昂贵的住院治疗，以解决社会决定因素，因此提供了更具说服力的理由，以提供可持续资金来提供可持续资金such interventions,” according to the CAI’s research

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