October 2004, Medicaid paid $16 million in claims for 17,779 Community Care patients. Table 1 shows the monthly cost savings from converting asthma,.
Developing a Framework for Conducting Economic Evaluations of Community-Based Health Information Technology Interventions Eric L. Eisenstein, D.B.A.1, Kevin J. Anstrom, Ph.D.1, Jennifer M. Macri, M.S.2, David R. Crosslin, M.S. 1, Frederick S. Johnson, M.B.A.2, Kensaku Kawamoto 2, and David F. Lobach, M.D., Ph.D., M.S2. 1 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 2 Department of Community & Family Medicine, Duke University Medical Center, Durham, NC Abstract This study describes a framework for conducting economic analyses for health information technology (HIT) interventions, in the context of three interventions that are currently being implemented in a community-based health network caring for 17,779 Medicaid beneficiaries in Durham County, North Carolina. We show that if the HIT interventions were to redirect only 10% of low-severity emergency room encounters to outpatient care, it will result in $12,523 of monthly savings. Background There is currently no consensus regarding the best methods for linking information system investments to health system value. Our work in the health information technology (HIT) Value study introduces a general framework for evaluating the economic attractiveness of health information technologies, and estimates the economic effect size required to demonstrate that the intervention is cost-neutral, or cost-saving, for this health care system. Methodology The HIT Value study will conduct a randomized trial of three health information technology interventions within the Durham Community Health Network’s Community Care program, a community-based collaborative partnership that focuses on health care delivery to 18,000 Medicaid beneficiaries in Durham County, North Carolina. The interventions are: (1) email communication of alerts to care providers (case workers and health providers); (2) distribution of patient feedback reports to clinic managers; and (3) mailing of care reminders directly to patients. Our economic analysis hypothesizes that the incremental cost associated with the three HIT interventions will be more than offset by resulting cost savings in other components of the healthcare system. This hypothesis is based upon the assumption that the HIT Value study will redirect asthma, diabetes, and other lowseverity patients from expensive, inappropriate care (emergency room and inpatient) to less expensive appropriate care (outpatient provider visits). Our results will be based upon empirical data to be prospectively collected for the HIT Value economic analysis. Two types of economic data will be
required: the total costs of each information technology intervention (development and operations) and the total medical costs for study patients (estimated using Medicare standard costs). Economic Effect Size Results During the 3-month period from August through October 2004, Medicaid paid $16 million in claims for 17,779 Community Care patients. Table 1 shows the monthly cost savings from converting asthma, diabetes, and low-severity emergency room visits to outpatient office visits. The columns show the estimated number of emergency room visits per month and the potential savings for each visit redirected. Potential savings shows the amount that would be saved if all visits were converted and succeeding columns show the amount saved with less than perfect conversion. Table 1: Estimated Monthly Cost Savings Patient Type Emergency Estimated Room Visits / Savings / Month Visit Asthma 59.7 $324 Diabetes 18.7 $208 Low-Severity 635.7 $197 Savings From Visit Conversion Potential 10% Asthma $19,332 $1933 Diabetes $3883 $388 Low-Severity $125,226 $12,523 Savings From Visit Conversion 20% 30% Asthma $3866 $5800 Diabetes $777 $1165 Low-Severity $25,045 $37,568 Conclusion This study demonstrates that HIT interventions may be evaluated using the same techniques as other health care interventions. With only 10% of lowseverity emergency department visits converted to office visits, there will be an estimated $12,523 monthly savings in medical costs to the Medicaid system.
AMIA 2005 Symposium Proceedings Page - 948
