The Business Case for Pediatric Asthma Quality Improvement
Characteristics of the participating practices are shown in Table 1. There were 3721 eligible children seen by treatment practices and 4010 seen by control practices. Among treatment practices, ~20% were small (<100 eligible children), 40% were medium (100–300 eligible children) and 40% were large (>300 eligible children) compared with 14% small, 44% medium and 42% large for control practices. The differences were not statistically significant. There were no statistically significant differences in populations of children seen by treatment versus control practices except for race/ethnicity. Control practices saw a higher percentage of children who were black (32.9 versus 21.5%) while treatment practices saw a higher percentage of children who were Hispanic (23.7 versus 12.8%). Less than 20% of children in both the treatment and control groups had ED visits for asthma in the baseline period, and <1% had hospital admissions for asthma. There were no significant differences between treatment and control groups in terms of baseline ED or hospital utilization.
Results of the difference-in-differences regressions are shown in Table 2. Across the sources of care, the highest expenditures were found for pharmacy and office-based claims followed by ED and outpatient care. Across all practices, average expenditures on office-based care increased in the first intervention year, and the increase was statistically significant. Average expenditures on ED visits increased in both the first and third intervention years, and expenditures on outpatient care increased in all years. For practices enrolled in PACE, expenditures on ED visits increased more than in control practices in both the first and second intervention years. There were no other statistically significant differences between treatment and control practices in any of the specific spending categories; however, despite lower spending on all services at baseline, spending in treatment practices grew at a greater rate than in control practices in the second intervention year.
The largest cost associated with the PACE intervention was the incentive payments made to participating practices in the treatment group which accounted for 52, 65 and 80% of the total costs to operate the PACE intervention in Years 1, 2 and 3, respectively (Table 3). After the incentive payments, the next highest cost category was personnel time. While the majority of personnel costs were not new, and thus were not truly incremental, the full reported cost is used to capture the opportunity cost associated with the time spent developing the PACE intervention and online chart audit tool, monitoring data collection, and interacting with practices. Other costs included the chart audit software, office, travel and training, and indirect costs.
The Monroe Plan experienced increases in annualized net claims payments during the PACE intervention of $99 216 and $293 180 in the first and second years, and $29 363 for the 6 months of the intervention's third year (values discounted at 3% are shown in Table 4). Only expenditures in the second year, however, were statistically significantly different from zero. Overall, the Monroe Plan experienced a loss on the PACE intervention as reflected by the negative net present value of $785 095.
Results
Characteristics of the participating practices are shown in Table 1. There were 3721 eligible children seen by treatment practices and 4010 seen by control practices. Among treatment practices, ~20% were small (<100 eligible children), 40% were medium (100–300 eligible children) and 40% were large (>300 eligible children) compared with 14% small, 44% medium and 42% large for control practices. The differences were not statistically significant. There were no statistically significant differences in populations of children seen by treatment versus control practices except for race/ethnicity. Control practices saw a higher percentage of children who were black (32.9 versus 21.5%) while treatment practices saw a higher percentage of children who were Hispanic (23.7 versus 12.8%). Less than 20% of children in both the treatment and control groups had ED visits for asthma in the baseline period, and <1% had hospital admissions for asthma. There were no significant differences between treatment and control groups in terms of baseline ED or hospital utilization.
Results of the difference-in-differences regressions are shown in Table 2. Across the sources of care, the highest expenditures were found for pharmacy and office-based claims followed by ED and outpatient care. Across all practices, average expenditures on office-based care increased in the first intervention year, and the increase was statistically significant. Average expenditures on ED visits increased in both the first and third intervention years, and expenditures on outpatient care increased in all years. For practices enrolled in PACE, expenditures on ED visits increased more than in control practices in both the first and second intervention years. There were no other statistically significant differences between treatment and control practices in any of the specific spending categories; however, despite lower spending on all services at baseline, spending in treatment practices grew at a greater rate than in control practices in the second intervention year.
The largest cost associated with the PACE intervention was the incentive payments made to participating practices in the treatment group which accounted for 52, 65 and 80% of the total costs to operate the PACE intervention in Years 1, 2 and 3, respectively (Table 3). After the incentive payments, the next highest cost category was personnel time. While the majority of personnel costs were not new, and thus were not truly incremental, the full reported cost is used to capture the opportunity cost associated with the time spent developing the PACE intervention and online chart audit tool, monitoring data collection, and interacting with practices. Other costs included the chart audit software, office, travel and training, and indirect costs.
The Monroe Plan experienced increases in annualized net claims payments during the PACE intervention of $99 216 and $293 180 in the first and second years, and $29 363 for the 6 months of the intervention's third year (values discounted at 3% are shown in Table 4). Only expenditures in the second year, however, were statistically significantly different from zero. Overall, the Monroe Plan experienced a loss on the PACE intervention as reflected by the negative net present value of $785 095.
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