Asthma bottom line: Return on investment analysis of a collaboration between a managed care organization and a New York City Department of Health asthma control program

OBJECTIVES: We collaborated with a large Managed Care Organization (MCO) to locate children with poorly controlled persistent asthma in East Harlem using MCO prescription drug and medical service utilization data. We enrolled these children into a comprehensive asthma education and case management intervention run by the Harlem District Public Health Office (DPHO) within New York City's Department of Health. Using MCO data, we measure reductions in hospitalizations and ED visits of participants one year after program enrollment. We also measure cost savings to the system by looking at change in health care expenditures of participants relative to asthma program costs via a return on investment (ROI) analysis. METHODS: In January of 2009, the MCO and Harlem DPHO entered into a contract and business agreement to provide comprehensive asthma care services to MCO clients with poorly controlled persistent asthma. Using data on the number of hospitalizations, ED visits and asthma medication prescriptions, the MCO identified clients ages 1-17 years with poorly controlled persistent asthma living in East Harlem (zip codes 10029, 10035 and 10037). The DPHO recruited and enrolled these clients into an extant comprehensive asthma education and case management program which provided services for a period of at least one year. We stratify participants in the DPHO asthma program by intensity of their participation. We pair participants with age and disease severity matched controls. Using MCO data, we calculate the ROI of this MCO-DPHO collaboration by comparing cost of the DPHO asthma program with cost savings in medical expenditures of clients over the program period. RESULTS: Of 5,582 MCO members in East Harlem as of January 1, 2009, 887 (15%) carried a medical diagnosis of asthma. Of these members, 301 (34%) met the NIH criteria for poorly controlled persistent asthma. Of the 301, only 196 (65%) received inhaled corticosteroids per NIH guidelines. 58 (19%) of the 301 clients were enrolled in the DPHO asthma program. The MCO reports a one year savings of $303,532 for the 301 clients originally referred to the DPHO asthma program. A breakdown of this number is on-going and program participants at varying levels of program participation are being compared to age and disease severity matched controls. CONCLUSIONS: Public Health Departments and Health Insurance Companies are viable partners in elucidating disease incidence and disease cost data. MCO utilization data can help public service organizations evaluate the net financial impact of their programs via an ROI analysis.