An iron triangle ROI model for health care

Area of Science:

• Health economics
• Health services research
• Health informatics

Background:

• Traditional return on investment (ROI) analyses for health programs often overlook patient access, focusing primarily on cost savings and quality improvements.
• Incorporating patient access into ROI models is crucial for a comprehensive evaluation of healthcare initiatives.

Purpose of the Study:

• To develop an open-source model for ROI analysis that systematically includes estimations of patient access gains.
• To propose a classification system for quantifying improvements in patient access.

Main Methods:

• An Excel-based ROI model was created, integrating traditional metrics (cost savings, avoided patient cases) with patient access changes.
• The model was applied to a case study involving New Mexico Medicaid data and two initiatives: a statewide health information exchange (HIE) and a community health worker (CHW) program for chronic disease patients.
• Estimates for savings, health outcomes, outreach, and access were derived from existing literature.

Main Results:

• The combined HIE and CHW programs are projected to achieve a positive ROI by the fourth year, reaching 45% by year ten.
• Total estimated cumulative costs over ten years are $9,555,226, with estimated cumulative savings of $11,332,899.
• Patient access scores are estimated to increase from 19 in year 1 to 380 by year 10, with associated access costs growing from $122,766 to $1,858,274.

Conclusions:

• The developed model effectively incorporates patient access gains into traditional ROI analyses.
• The case study suggests that implementing a CHW program and a statewide HIE can yield a positive ROI for state Medicaid programs.