Return on Community Investment (ROCI):
A High Impact Institute

Pre-Conference Data Collection
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Return on Community Investment Survey Responses

Respondent Name:

Michael DeLucca

E-Mail Address:

mdelucca@brhpc.org

Organization Name:

Broward Regional Health Planning Council

Phone:

(954) 561-9681   Ext. 252

Fax:

(954) 561-9685

Address:

915 Middle River Drive   Suite 120

City, State, Zip:

Fort Lauderdale, FL    33304
Category: Your Community

What is the service area of your initiative (counties, city, etc.)?

Broward County, Florida

What is the total population in your service area?

1,623,018

What percentage of the total population lives below the federal poverty level?

12-14%

What percentage of the total population is uninsured?

14.8%
Category: Your Program Initiative

Indicate which of the following categories your initiative falls in:

Securing public and private insurance coverage
Emergency room usage reduction
Case management of chronic disease

Describe the purpose of your initiative (in one sentence, if possible):

To improve clinical and quality of life outcomes for uninsured and underinsured persons with asthma, diabetes, and HIV/AIDS.

Describe the scale of your initiative in terms of budget, capacity, etc.:

The project has a $460,000 budget with each disease state manager serving one hundred and fifty to two hundred clients.

Describe the operational components of your initiative:

Information and Referral Pre-eligibility Screening Disease Management Education Evaluation

Describe your initiative's staffing level:

Project Director Disease State Managers Help Line Workers Evaluator

If applicable, please describe your strategic use of an information system:

Stand alone databases were created at both hospital districts to capture clinical outcomes, quality of life indicators, reduction in hospitalizations/ ED visits, and cost usage data. Information from these systems is deidentified and uploaded to a central location for analysis.

Please list the major, time-framed, measurable objectives your initiative is designed to achieve:

Increase clients enrollment in insurance programs. Improve clinical lab values. Improve client quality of life. Decrease inappropriate emergency department use. Decrease hospitalizations. Increase the number of clients with a medical home. Decrease overall disease related medical costs
Category: Measurable Results

Which of the following results can be attributed to your program initiative? Please check all that apply.

Coordinated System of Care Savings
Reduction of ER usage for non-urgent care
Savings from operational improvements within integrated system
Qualifying people for government subsidized programs
Increasing awareness of programs and services
Services brought into the community
Pharmaceuticals acquired on behalf of clients
Improved health status

Please list any other actual, measurable results of your initiative:

Improve clinical outcomes. Improved quality of life. Decreased costs. Decreased emergency department visits. Decreased length of hospital stays.
Category: Your ROCI Strategy

How do you define ROCI?

ROCI is what a community including key stakeholders and consumers receive as a result of an investment in program/ intervention/ or system.

Describe your ROCI objectives and strategy:

Design an information system to measure the financial act of the disease management program. 1)calculate the number of hospitalizations (days) and emergency department visits for each patient during the year prior to program entry and compare to the same variables for each patient while in the program 2) calculate the cost savings realized by enrolling patients into insurance programs

Describe the players involved in the ROCI conversation (by title and/or function):

Senior Vice Presidents of both Hospital Districts CEO Regional Health Planning Council CEO Federally Qualified Health Center Administrator of Local Health Department CEO Coordinating Council of Broward Medicaid District Administrator Disease State Management Program Supervisors CEO First Call For Help Hospital Districts MIS Managers CAP Program Director CAP Evaluator

List the milestones in your ROCI strategy that pertain to deal making (a prospective approach):

Creation of a uniform database across hospital districts Signed contracts between the lead agency and hospital districts to export de-identified data Working with hospital district MIS departments to write programs to link program database to mainframe database in order to streamline the downloading of patient hospitalization information Testing and refining of databases including working with disease managers to correct data problems and ensure completeness of data Uploading and analyzing de-identified data Reporting outcomes back to stakeholders and community Improving data collection methods Once outcomes were collected which showed a decrease in costs related to hospitalizations, this information was used to get buy in to support additional disease management programs and to bring all parties to the table to collaboratively apply for grants to sustain funding

List the milestones in your ROCI strategy that are tied to outcomes (a retrospective approach):

Once outcomes were collected which showed a decrease in costs related to hospitalizations, this information was used to get buy in to support additional disease management programs and to bring all parties to the table to collaboratively apply for grants to sustain funding

List the milestones in your ROCI strategy that are linked to sustainability:

1) Documentation of decreased inappropriate use of the emergency department 2) Documentation of decreased inpatient hospitalizations 3) Documentation of improved clinical outcomes 4) Documentation of cost effectiveness and return on investment 5) Use of the above documentation to apply for funding from diverse sources
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

The total cost of patient hospitalizations and emergency department visits by each disease category (asthma, diabetes, and HIV/AIDS) was tracked and calculated for patients one year prior to program entry and was used to determine the average cost of treatment per patient. The same process was then used to determine the average cost per patient while in the program. A second phase of this process involves calculating the cost savings realized by patients not having missed work days due to hospitalizations/ emergency department visits. By screening and consequently enrolling patients into insurance programs, the cost of future primary care and hospitalizations will not be incurred by the hospital districts and Federally Qualified Health Center. The strategy for calculating the ROI of this component was to calculate the number of patients enrolled in insurance programs due to this program and multiply that number by an average cost of an annual insurance premium ($4,000). An alternative to this approach that will be employed in subsequent years is to subtract the total cost of insurance premiums for those insured from the average total cost of those same clients if they were treated in the emergency department and inpatient units (based on the calculation from the baseline).

Is your method supported by scientific research? If yes, please describe:

Yes, a review of the current return on investment and cost effective literature in healthcare was performed. The ROCI plan for this project has been modeled after the research and has two further implementation stages in order to realize the full extent of the literature recommendations.

Describe the measures that you used to define "returns" or value:

Decreased hospitalizations (hospital days) and associated costs. Decreased emergency department visits and associated costs. Decreased overall costs through patient enrollment in insurance programs. Increased Quality of Life as measured by nationally recognized scales. Improved clinical lab values. Increased patient satisfaction. Increased provider satisfaction.

Describe the measures that you used to define investments or costs:

Average cost of disease specific hospitalizations prior to enrollment versus during enrollment Average cost of disease specific emergency department visits prior to enrollment versus during enrollment Average saving due to enrollment in insurance programs.

Please briefly describe your data collection methods.

Creation of a uniform database across hospital districts Working with hospital district MIS departments to write programs to link program database to mainframe database in order to streamline the downloading of patient hospitalization information Testing and refining databases including working with disease managers to correct data problems and ensure completeness of data Uploading and analyzing de-identified data Reporting outcomes back to stakeholders and community Improving data collection methods
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

Numerous meetings with stakeholders, program director, MIS staff and evaluators to clarify data collections, data analysis scenarios, calculation methods, and roles and responsibilities. On-going meetings with stakeholders to determine future funding sources.

Describe how ROCI conversations are tailored to specific audiences:

Issues are presented from consumer, administrative and evaluative perspective depending on audience.

Describe what enabled effective conversations to occur:

Trust, long standing relationships, a coordinated vision of healthcare for the community.
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

Decreased hospitalizations (hospital days) and associated costs. Decreased emergency department visits and associated costs. Decreased overall costs through patient enrollment in insurance programs. Increased Quality of Life as measured by nationally recognized scales. Improved clinical lab values. Increased patient satisfaction. Increased provider satisfaction.
Category: Lessons

What do you see as the critical success factors that can guide others?

Trust and collaboration between community partners. Development of management information systems to capture complex data. Willingness to reform data collection processes. Willingness to share patient data.

Do you believe that your results can be replicated successfully with other similar initiatives? Can you suggest how replication may be facilitated?

Yes, formally through technical assistance and informally through quarterly and annual reports.
Category: Share Your Resources

Resource Files you've shared with us:

CAPPh3ReportWeb.pdf
ROCI HCAP Disease Management.ppt
Category: Finalize Survey Responses

Please list any websites that provide valuable ROCI information:

http://www.brhpc.org/cap/