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:

Eric Scorsone

E-Mail Address:

escorson@uky.edu

Organization Name:

Valley Health Systems, Inc.

Phone:

(859) 257-7257   Ext.

Fax:

(859) 257-7290

Address:

University of Kentucky   

City, State, Zip:

Lexington, KY    
Category: Your Community

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

Three counties

What is the total population in your service area?

85,000

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

25%

What percentage of the total population is uninsured?

50%
Category: Your Program Initiative

Indicate which of the following categories your initiative falls in:

Outreach and navigation
Primary care capacity and access
Emergency room usage reduction
Case management of chronic disease
Access to affordable pharmaceuticals

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

This collaborative’s goal is broadly defined to improve access to health care, social services and housing for the under and uninsured residents of Harlan and Perry counties and is a community partnership with the University of Kentucky Center for Rural Health, Hazard, KY; Harlan Counties for a Healthy Community, Inc., Harlan, KY; Hazard Perry County Community Ministries, Inc., Hazard.

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

09/00 - 08/01: $1,462725; 09/01-08/02:$552,107; 09/02-08/03:$368,382---employing 11 case workers

Describe the operational components of your initiative:

SKYCAP uses lay health workers, called Family HealthCare Navigators (FHN) to improve the health of the target population, who face barriers such as inadequate insurance. ii. FHNs work as a liaison between clients and their families, mental health and health and human service providers to enable and facilitate our work. FHNs report to network members the specific characteristics of conditions, which impede clients from obtaining available services. iii. By working with multi disciplinary teams to establish action plans for clients and families, our safety-net providers improved the way they related to each other. This method assured action plans were carried out, linked clients with all needed services; connected clients to support groups; provided emotional and educational support for clients and their families.

Describe your initiative's staffing level:

11 case workers and 4 administrative staff

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

SKYCAP tracks its work with low income families using a unique Management Information System, created by Data Futures, Inc in collaboration with all the project partners. This system provides a responsive data source for details with regard to all factors that effect health, from ambulatory sensitive diseases such as asthma, diabetes, hypertension, heart disease and severe mental illness to living conditions. SKYCAP’s data management allows its partners to collect accurate tracking information on its clients and allows every entity addressing that person’s needs to instantly see resources and gaps. This unique system provided not only providers, but the patients, with the information they need to effectively access health services.

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

• To provide a holistic care management system for mental, physical health, and environmental services for the uninsured/underinsured through a network of local service providers coordinated by Family Health Navigators. • To design and implement a Management Information System to link providers, track target population, implement a common client record and provide data to measure outcomes. • To reduce unnecessary hospitalizations and inappropriate use of emergency room for individuals with ambulatory care sensitive diseases of asthma, diabetes, hypertension, heart disease, and mental illness. • To develop a pharmaceutical access program to be managed by the Family Health Navigators. • To plan for the eventual expansion of the program throughout the region.
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
Pharmaceuticals acquired on behalf of clients
Volunteer contributions
Improved health status
Economic development factor
Increased attendance at work
Increased attendance at school

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

The positive impact of SKYCAP services are reflected in the data in the table below. These data indicate that SKYCAP services significantly reduced hospital admissions and the use of hospital emergency rooms for the ambulatory sensitive diseases on which the program concentrates and as a result produce significant savings for the health care system of the four-county target area. SKYCAP services resulted in a reduction of 88% in hospital admissions, a reduction of 92% in emergency room visits, and produced a cost savings of $1,343,250. The consortium referral system is in place and working well; we have received over 8,000 referrals from 49 different agencies in the period September 1, 2000-July 31, 2003. A total of 72,663 services for the uninsured/underinsured population have been rendered.
Category: Your ROCI Strategy

How do you define ROCI?

The net monetary valued benefits derived by society due to the existence of the community access program

Describe your ROCI objectives and strategy:

1) promote the program in the community to ensure funding sustainability 2) demonstrate the value of the program to the general public, community leaders and funders 3)ensure that the program, as it is currently operating, is generating a net benefit to society

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

Fran Feltner, SKYCAP Director, UK Eric Scorsone, Assistant Professor, UK Ellen Napier, Administrative Coordinator SKYCAP Harlan and Perry county hospitals

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

Continue on an annual basis to undertake a community return on investment analysis and present results to key partners; use information to continue to improve program

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

1)Funding sustainability from key partners once federal funding is removed 2)program expansion to other eastern and western Kentucky counties based on ROCI results

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

No response.
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

Economic Cost Benefit analysis. Describes the valuation of net social benefits over social opportunity costs using a financial rate of return formula. Benefits and costs are viewed from the perspective of society as opposed to the program or counties involved.

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

Yes, it is supported by 50 years of research in economics which is to lengthy to list here but could be compiled in a separate document. My major sources of background material include the book of ''Economic Analysis of Investment Operations'' from the World Bank press.

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

ER Cost Savings, Educational or Housing services accessed, Donated Pharmaceuticals

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

Labor costs, donated time and materials, material and utility costs

Please briefly describe your data collection methods.

Data was primarily collected from budget reports and the SKYCAP MIS system along with extensive personal interviews
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

Primarily community and legislative presentations tied to discussions about financial funding and sustainability

Describe how ROCI conversations are tailored to specific audiences:

Discussion is tailored based on technical expertise of audience and based on audiences specific context, local government versus state government

Describe what enabled effective conversations to occur:

graphical presentation of numbers, provide comparisons of numbers to other types of public investments
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

Most desired outcome is financial sustainability and possible expansion of SKYCAP program...still waiting on the actual outcome of this process
Category: Lessons

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

Need to provide hard numbers that allow policymakers to compare these investments to other types of public investments such as roads, schools, etc...

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

Yes, replication of these results will require a trained professional to ensure economic standards are adhered to that will hold up under scrutiny
Category: Share Your Resources

Resource Files you've shared with us:

Finalized TA conference call.ppt