Community Asthma Initiative: Cost Analyses using Claims Data from a Medicaid Managed Care Organization

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).

Keywords:

• Pediatric asthma
• return on investment (ROI)
• claims data
• home visits
• community health workers (CHWs)
• case management
• medical expenses

Acknowledgment

The authors would like to thank Kyra Shreeve, BS, for her comments and assistance with submission of this manuscript.

Disclosure statement

All authors have indicated they have no potential conflicts of interest to disclose. All authors have indicated they have no financial relationships relevant to this article to disclose.

Funding

This project was supported in part by HRSA/MCHB of the U.S. Department of Health and Human Services (HSS) through the Boston Children’s Hospital Leadership Education in Adolescent Health (LEAH) training grant, T71MC00009 and Healthy Tomorrows grant #H17MC21564. This content and conclusions are those of the authors and should not be considered as an official position or policy of, nor should any endorsements be inferred by HRSA, HSS or the U.S. Government. In addition, funding is in part from BCH PPSQ grants; Shark, Ludcke, Covidien, Boston Scientific, Thoracic and BJ Foundations; and Office of Community Health (OCH).