Investing in Interventions That Address Non-Medical, Health-Related Social Needs Proceedings of a Workshop (2019) / Chapter Skim
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6 Return on Investment
6 Return on Investment
Pages 59-66
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From page 59... ...
Some interventions, for example, may improve patient satisfaction, improve provider satisfaction, reduce provider burnout, or improve quality measures. (Alley, Knutson)
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From page 60... ...
. The Value of Health Tool uses intervention-specific effects as a function of age on mortality, morbidity, health care costs, earnings, and incarceration costs plus generic economic inputs to produce as its output an overall value to different stakeholders, the effect of health care spending by different stakeholders, and the maximum investment to achieve the
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From page 61... ...
Miller and his colleagues have used this tool for a variety of interventions, including • early childhood interventions; • trauma prevention; • smoking prevention; • obesity prevention; • the burden of the opioid epidemic; • lead exposure mitigation at the national, state, and city level; • pediatric asthma in a Medicaid population; and • the use of long-acting reversible contraceptives in a Medicaid population. As an example, Miller looked at the effect of reducing childhood exposure to lead poisoning using three particular interventions: service line replacements to eliminate lead in household drinking water, controlling exposure to lead paint in older homes, and using lead-safe standards when repairing older homes that may have lead in them.
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From page 62... ...
is considering a new coverage decision for a medical procedure, it bases that decision on clinical effectiveness, rather than cost effectiveness. However, for a prevention intervention tested through the CMS intervention the goal is to remain at lease cost-neutral and have an ROI of at least 1:1.
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From page 63... ...
On a closing note, she said that CMS recognizes there are other forms of ROI beyond financial and that there are many other drivers of provider behavior in a value-based environment. Some interventions, for example, may improve patient satisfaction, improve provider satisfaction, reduce provider burnout, or improve quality measures.
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From page 64... ...
DISCUSSION To start the discussion period, John Auerbach noted that most medical services get approved for reimbursement with no ROI analysis, as demonstrated by the incredibly high-cost services offered at the end of life even when the evidence suggests there will be little benefit in terms of extending life or improving the quality of life. In contrast, it seems that interventions to address non-medical, health-related social needs have to meet a high ROI standard.
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From page 65... ...
She then noted the need for anyone considering regulatory proposals to consider what specific requirements they would want and how they would codify evidence-based interventions or the desired health outcome. Knutson did not suggest any recommendations but did note that she has seen through her experience of being part of three accountable care organizations that value-based payment arrangements are incentivizing health systems to look at the non-medical drivers of health care costs and make investments in behavioral health, social determinants,
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From page 66... ...
She noted that in the course of conducting research in some of the nation's poorest communities, they identify unmet needs and address them so people continue participating in clinical trials. After commenting that regulations around quality metrics might be able to play a role in incentivizing health care systems to work more on social needs, Miller suggested that it would be helpful if Medicare and Medicaid continued loosening some restrictions around what constitutes an appropriate investment beyond those on direct health care.
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