What Are You Worth

1
What Are You Worth?

• Demonstrating the Value of Your Program to Your
  Community and Potential Investors
• Ethan Joselow, MPH

2
Presentation Goals

• To give an overview of common methods for
  demonstrating your value.
• To provide a set of tools that you can use to
  define the value of your program for
• Your community
• Potential investors
• (grantmakers, the state, the community itself)

3
Presentation Structure

• Understanding the costs avoided, savings enjoyed
• Cost-benefit analysis
• Cost-comparison analysis
• Social Costs Avoided
• Sick days, wages
• Health Costs Avoided
• ER visits, hospitalizations

4
1. Cost-Benefit Analysis
Looking at a program on its own

• What were your programs costs?
• Budget Fixed and recurring costs
• What costs were avoided as a result?
• Lost time, wages, health care costs
• AKA Parts 2 and 3 of this presentation.
• Are the avoided costs greater than the programs
  costs?

Challenge How do you find savings?
5
1. Cost-Benefit Analysis
The Company X Worksite Wellness Program
Adapted from RTI-UNC Center of Excellence in
Health Promotion Economics November 2006 Volume
1, Issue 3.
6
1. Cost Comparison Analysis
Comparing two otherwise equal program choices

• Need to know
• Upfront costs
• Recurring (unit) costs
• Number of units delivered
• Ideal for
• Considering efficiency and practicality
• Talking to funders about long-term savings from
  an initial investment

7
1. Cost-Comparison Analysis
Program Goal To monitor blood pressure, weight
and a few other clinical measures for a homebound
rural population.
Value Statement After 900 units of monitoring,
the telehealth system saves us 15,300 over nurse
visits.
8
2. Social Costs Avoided

• Information on avoided sick days, lost
  productivity saved through services you provide.
• Evidence and Estimates.
• Especially useful for speaking to employers and
  their representatives.

9
2. Social Costs Avoided

• What do you need to make an estimate?
• Your evaluation data
• Number served, cost of the intervention.
• Research on the value of your intervention
• Journal articles, evaluations of similar
  programs
• Local information
• Average wage, labor participation rate

10
2. Social Costs Examples

• The Facts
• In 2004, Georgia Federally-Qualified Community
  Health Centers (FQHCs) treated
• About 24,000 Diabetic Workers.
• About 12,000 Hypertensive Workers.
• The state average annual wage was
• About 24,000 per year.

evaluation data
local information
11
2. Social Costs Examples

• The Research

or about 3 more workdays.
or about 6 more workdays.
A person with uncontrolled hypertension works an
average of 6 percent fewer hours per week
compared to someone receiving proper care and
attention. This works out to about 20 days of
work lost a year.
The average untreated diabetic has 8.3
additional sick days a year. Proper diabetes
management can reduce sick days to 1.4 per year.
Economic Consequences of Diabetes Mellitus in
the US in 1997 Diabetes Care, 1998 Feb
21(2)296-309.
Berndt ER, et al. Workplace Performance Effects
from Chronic Depression and its Treatment.
Journal of Health Economics, 1998 17 511-535.
12
2. Social Costs Avoided

• The Savings
• Sick days earnings saved by treatment of
  diabetes 8,352,470
• Cost to treat 5,961,144
• Sick day earnings saved by treatment of
  hypertension 34,907,048
• Cost to treat 10,138,394

a return of 1.40 for each dollar spent.
a return of 3.50 for each dollar spent.
13
3. Health Costs Avoided

• Medical Expenditures Per Patient
• Do you promote physical activity?
• If so, you may be saving 1365 a year in medical
  expenses for every inactive patient you get
  moving.
• Ask the local hospital how much of that money is
  likely coming out of their pockets.
• You save them money.

Pratt M, Macera CA, and Wang G. Higher Direct
Medical Costs Associated With Physical
Inactivity The Physician And Sportsmedicine
28(10). October 2000 . Dollar figure for 2006
based on medical inflation estimated between 1987
and 2006 by the CMS National Health Expenditures
tables.
14
3. Health Costs Diabetes Savings

• Research shows a decrease in health care costs by
  reducing HbA1c levels of diabetics.

Adapted from Gilmer TP, O'Conner PJ, Rush WA,
Crain AL, Whitebird R, Hanson AM, Solberg LI
Predictors of Health Care Costs in Adults with
Diabetes. Diabetes Care 28(1) 59-64, 2005.
15
3. Health Costs Diabetes Savings
966 x 50 48,000 savings in health care costs
What does this mean for us?
Adapted from Gilmer TP, O'Conner PJ, Rush WA,
Crain AL, Whitebird R, Hanson AM, Solberg LI
Predictors of Health Care Costs in Adults with
Diabetes. Diabetes Care 28(1) 59-64, 2005.
16
A Few Sources

• Web-based ROI calculators you can use NOW.
• Alcohol Cost Calculator
• http//www.alcoholcostcalculator.org/
• Obesity Cost Calculator
• http//www.businessgrouphealth.org/healthtopics/ob
  esitycostcalculator.cfm
• ROI Forecasting Calculator
• http//www.chcsroi.org/Welcome.aspx

17
Our Library of Resources

• Access to Care and ER Visits
• Behavioral Health
• Case Management and Promotoras
• Data Resources and Methodology
• Diabetes and Obesity
• Economic Impact Analysis and General ROI
• HIT
• Maternal/Child Health
• Migrant/Seasonal Farmworkers
• Prescription Drugs

18
The CHSD ROI Calculator

• A stand-alone tool developed by the TA team
  especially for rural health.
• Download the calculator at http//CHSDOnline.com

19
Questions?

• Ethan Joselow
• ejoselow_at_gsu.edu
• 404-413-0299