Return on investment of self-management education and home visits for children with asthma

Abstract

Objective

Priorities of the Centers for Disease Control and Prevention’s 6|18 Initiative include outpatient asthma self-management education (ASME) and home-based asthma visits (home visit) as interventions for children with poorly-controlled asthma. ASME and home visit intervention programs are currently not widely available. This project was to assess the economic sustainability of these programs for state asthma control programs reimbursed by Medicaid.

Methods

We used a simulation model based on parameters from the literature and Medicaid claims, controlling for regression to the mean. We modeled scenarios under various selection criteria based on healthcare utilization and age to forecast the return on investment (ROI) using data from New York. The resulting tool is available in Excel or Python.

Results

Our model projected health improvement and cost savings for all simulated interventions. Compared against home visits alone, the simulated ASME alone intervention had a higher ROI for all healthcare utilization and age scenarios. Savings were primarily highest in simulated program participants who had two or more asthma-related emergency department visits or one inpatient visit compared to those participants who had one or more asthma-related emergency department visits. Segmenting the selection criteria by age did not significantly change the results.

Conclusions

This model forecasts reduced healthcare costs and improved health outcomes as a result of ASME and home visits for children with high urgent healthcare utilization (more than two emergency department visits or one inpatient hospitalization) for asthma. Utilizing specific selection criteria, state based asthma control programs can improve health and reduce healthcare costs.

Keywords:

• Asthma
• cost
• return-on-investment
• asthma self-management education
• asthma home visit program

Acknowledgements

The analysis described was supported by the Centers for Disease Control and Prevention (CDC), including the Office for the Associate Director for Policy and Strategy (OADPS) and the Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Medicaid claims data were available at Georgia Tech through support by the Institute for People and Technology, Stewart School of Industrial and Systems Engineering, and Children’s Healthcare of Atlanta.

Declaration of interest

No financial disclosures or conflicts of interest were reported by the authors of this paper.

Additional information

Funding

This manuscript was created with support from Contract No. 200–2014-59300, RFTOP 2015-A-0005, Strengthening Health and Cost Impact Analysis for Prevention Policy Strategies, Centers for Disease Control and Prevention.