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Community Asthma Initiative: Cost Analyses using Claims Data from a Medicaid Managed Care Organization
Urmi Bhaumik1,2, Susan J Sommer2, Ryan Lockridge3
1Office of Community Health, Boston Children's Hospital, Boston, MA, USA.
Insights
The Community Asthma Initiative (CAI), a home-visiting program, significantly reduced asthma-related healthcare costs. This nurse-supervised community health worker (CHW) intervention demonstrated a positive return on investment (ROI), proving its cost-effectiveness.
Area of Science:
- Public Health
- Health Services Research
- Health Economics
Background:
- Asthma is a significant public health concern, leading to high healthcare utilization and costs.
- Community-based interventions are increasingly explored to manage chronic diseases like asthma effectively.
- The Community Asthma Initiative (CAI) aimed to assess the economic impact of a home-visiting program.
Purpose of the Study:
- To evaluate the cost-benefit of the Community Asthma Initiative (CAI), a nurse-supervised community health worker (CHW) asthma home-visiting program.
- To determine the return on investment (ROI) of the CAI program using claims data.
Main Methods:
- Analysis of Massachusetts Medicaid Managed Care Organization (MCO) claims data from 2011-2016.
- Comparison of asthma-related utilization costs between 45 CAI patients and 45 cost-matched controls.
- Calculation of ROI based on cost reductions and program expenses.
Main Results:
- CAI patients experienced excess cost reductions of $806, $1,253, and $1,549 at 1, 2, and 3 years post-intervention, respectively.
- Adjusted ROIs were 0.31, 0.78, and 1.37 after 1, 2, and 3 years, indicating increasing cost-effectiveness over time.
- The reduction in asthma utilization costs surpassed the program's operational costs.
Conclusions:
- Home-based asthma programs delivered by nurse-supervised CHWs are cost-effective.
- Findings support integrating such secondary prevention services into payer reimbursement models or Accountable Care Organizations (ACOs).
- The CAI program presents a strong business case for payers and healthcare systems.
Abstract:
Objective: Use claims data to examine the cost benefit of the Community Asthma Initiative (CAI), a Boston area nurse-supervised community health worker (CHW) asthma home-visiting program. Methods: The reduction in asthma treatment costs was assessed using Massachusetts claims data from one Medicaid Managed Care Organization (MCO) in the north east that included all costs between January 1, 2011 and December 31, 2016. The data was used to determine asthma-related utilization cost reductions between 1 year pre- and 1, 2 and 3 years post-intervention. The cost reductions for 45 CAI patients and 45 cost-matched comparison patients were measured. Return on investment (ROI) was computed as the difference in cost reduction for CAI patients and a cost-matched comparison population divided by CAI program cost. Results: The excess reduction in per patient asthma-related utilization costs among CAI patients compared to the comparison population was $806 (p = 0.047), $1,253 (p = 0.01) and $1,549 (p = 0.005) between 1 year pre- and 1, 2 and 3 years post-intervention. These yielded adjusted ROI's of 0.31, 0.78 and 1.37 after 1, 2 and 3 years post-CAI intervention. Conclusions: The reduction in asthma utilization costs of a home visit program by nurse-supervised CHWs exceeds program costs. The findings support the business case for the provision of secondary prevention of home-based asthma services through reimbursement from payers or integration into Accountable Care Organizations (ACOs).
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