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On May 22, 2008, Rosanna Coffey presented the AHRQ Asthma Return-on-Investment (ROI) Calculator on a Web conference. These are the questions asked by participants during the event, with the associated answers.
Question: Can the Calculator be modified to obtain
return on investment calculations for other diseases?
Answer: The Asthma ROI Calculator only applies to
Question: Are physician visits to be included in
the outpatient visits category?
Answer: Physician visits are included in the outpatient
Question: Where are the payments for physician care
during an inpatient stay or an ER visit captured?
Answer: Payments for physician care during inpatient
stays and ER visits are captured under inpatient payments. Payments
for care that was provided in the physician's office are captured
under outpatient payments.
Question: Paid amount to facilities for inpatient
care vary. Does the cost reflect the average cost?
Answer: Facilities cost is an average of the paid
amount to the hospitals for people in the specified population.
Question: Did you say to use the 12 month Medical
Consumer Price Index (MCPI) change as a Discount Rate?
Answer: No. The discount rate that we used was an
annual inflation rate from the Consumer Price Index- which was 3%.
We're just trying to equalize the stream of medical care savings/cost
and the program costs which may be incurred at different times across
the study period, using the cost of money, generally, and the CPI
is relevant for that purpose. The federal government offers guidance
on Discount Rates (OMB Circular A-94, Appendix B). Check with your
State budget office for additional guidance.
Question: How can the ROI Calculator be used for
Medicaid programs that have the majority of their members enrolled
in managed care or full-risk capitation (other than the apparent benefit
of improved health outcomes/productivity gains)?
Answer: The managed care penetration (percentage
of members enrolled in managed care) for the MarketScan Medicaid data
that underlies the baseline estimates in the Calculator is 60%. If
your Medicaid program has a 60% penetration of managed care, the baseline
estimates should be appropriate for your population. If your penetration
rate is substantially higher or lower, you should consider the effect
of that qualitatively in using the estimates. The direction of the
impact should be:
• If your population has substantially more than 60% (80%
or more) in managed care, the Calculator savings may overstate the
effects you would see, because presumably managed care has already
reduced your spending on hospitalizations and perhaps emergency department
visits compared to the MarketScan experience.
• If your population has substantially less than 60% (40%
or less) in managed care, the savings may understate the effects you
would see, because presumably managed care has had less of an impact
on reducing your spending on hospitalizations and perhaps emergency
department visits compared to the MarketScan experience.
The best solution is to use baseline estimates calculated from your
Regarding the impact of quality improvement programs in managed versus
non-managed care environments, the meta-analysis does not take this
study feature into consideration because there are few studies that
have compared interventions in managed versus non-managed settings.
It is an open question whether programs in managed vs. non-managed
settings have a differential impact on costs.
Other Questions About the Calculator
Question: Is the tool available online? Will the
link be provided?
Answer: The Asthma ROI Calculator tool is in Excel
format, and is available by requesting via email at quality_tools@AHRQ.hhs.gov.
Question: How do I get started? I am having trouble
loading the Calculator and enabling the macro.
Answer: It may be necessary to adjust the security
level of Excel to enable the macros. If necessary, click Tools,
Macro, Security, the Security-Level tab, Medium, then OK. Once
you have successfully opened the Calculator, press the blue navigation
buttons at the top of your screen to view pages of the model. To
be sure to view all pages of the Calculator, make sure the resolution
of your computer monitor is 1024 x 768. To change the resolution,
right click on the desktop screen, select Properties, select the Settings
tab, slide the screen resolution slide bar to 1024 x 768, then click
Apply. If you are still having problems, please email us at quality_tools@AHRQ.hhs.gov.
Question: How can I get access to the articles in
Answer: In a paper that we can send you,
we have abstracts for the articles included in the meta-analysis and
even some not included. So you can go to the paper appendix, look
at the study abstracts, and then obtain the full text online or through
the journals themselves. To obtain the paper, please email us at quality_tools@AHRQ.hhs.gov.
Question: Will the literature review be updated
Answer: A literature review and update were performed
within the past year (as of March 2007). AHRQ has not made specific
plans for subsequent updates. It will likely depend on interest and
use of the tool.
Questions About Technical Assistance
Question: Would AHRQ be available to present this
tool to senior leadership of a state Medicaid program?
Answer: We are very interested in activities supporting
the use of this tool. Please contact the AHRQ project team at quality_tools@AHRQ.hhs.gov to
discuss technical assistance requests such as this.
Question: If a State decides to use the Calculator,
is assistance available to make sure that the appropriate inputs are
Answer: The AHRQ project team is available to assist
you in using the tool, including making sure the appropriate inputs
Current as of May 2009
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