CASE STUDIES

Estimating Cost-savings of fall-prevention and disease management

Situation: A non-profit organization provides classes for older adults to help prevent falls and improve self-management of chronic disease. They wanted to pitch their classes to health plans and recommend that they include them in their covered services. But to do that, they knew they would have to demonstrate to health plans that it was worth their investment.

Result: Through an extensive literature review and summary, we demonstrated the prevalence and cost of falls and poor management of disease management, as well as the documented success of the programs offered by this organization. Using estimates from published literature combined with the organization’s own data on enrollment and results (e.g., self-reported falls, improved knowledge and self-efficacy from the classes), we calculated an estimated cost-savings overall and per attendee. From these results we developed two white papers and other materials that the organization could use when presenting their case to health plans. 

Performing an Economic evaluation of QI Projects

Situation: An organization who had previously received funding to carry out several quality improvement projects wanted to understand the economic benefits their projects produced. They were curious to identify which projects produced the largest net monetary benefit and which aspects of those projects were the main drivers of those benefits. This would allow them to laud current successes and would provide the necessary information to estimate the potential economic impact of new opportunities needed to solicit federal funding.

Result: Using details of each project provided by the organization, I summarized the quality improvement activities and their impact, and then estimated the relevant impact on specific health metrics, care utilization, adverse events, and medication usage. Upon completion, this organization had a detailed report estimating the potential economic impact of their quality improvement efforts, and when possible, a breakdown of which activities produced the largest benefits.

 

Assessing the Value of an assistive device

Situation: A small medical device company designed and manufactured an external upper-arm support device for those whose mobility had been limited by diseases like multiple sclerosis and muscular dystrophy. This organization believed strongly that this device would help individuals maintain independence, improve emotional health, reduce caregiver burden, and extend their ability to live at home. They wanted tangible evidence of this from the published literature.

Result: I searched and summarized relevant literature to paint a clear picture of the common costs of care and the likely benefits from increased uppoer arm mobility for specific populations. The synthesized literature clearly demonstrated that disease progression results in a loss of mobility, greater dependence on others, and negative psycho-social effects. Addressing mobility can improve functioning and well-being and have a positive impact on care utilization as well as the financial and emotional strain on family members.

 

Determining the value of video-based medication observation

Situation: A groundbreaking organizatoin in the digital health field had developed a video-based medication dispenser that allowed for remote direct observation of therapy (DOT), a critical component of medication adherence for some populations. This organization understood that their device could make DOT more feasible and efficient while reducing medication errors and nonadherence.

Result: In addition to performing an extensive literature search and summary on the costs associated with medication errors and poor patient adherence, we developed a pilot study to test the feasibility and usability of the product. During this process, the organization was able to secure a partnership with an academic institution to seek further funding.

 

Evaluating Federal Reimbursement Policy

Situation: A national trade association of physicians wanted to understand how proposed policy changes to reimbursement methodologies could affect their member physicians. They had concerns regarding how care providers would be evaluated and compared to determine reimbursement levels, and intended to draft a letter to federal policy makers outlining their concerns.

Result: Using publicly available national data, I explored several hypothetical scenarios to compare current reimbursement criteria with the proposed criteria, to evaluate differences and potential issues associated with these differences. Together with the trade association, we developed a full description of what was done and pointed to specific hypothetical examples with graphs to illustrate the potential issues as we saw them. This analysis was included in a letter to policy makers in an attempt to draw their attention to potential drawbacks of their proposed methodology.

 

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American Medical Association (AMA) • Stratis Health • Oklahoma Foundation for Medical Quality • Optum • University of Minnesota • Indiana University • American Society of Clinical Oncologists (ASCO) • ICSI • Kidney Care Quality Alliance (KCQA) • Medtronic • NYU • Boston Scientific • Harvard Medical School • MPRO • Telligen • E4 Enterprise • Lee Branding • MetaStar