PROMOTORAS: A VALUE DRIVEN SOLUTION FOR COMMUNITY

Transcript:PROMOTORAS: A VALUE DRIVEN SOLUTION FOR COMMUNITY:
PROMOTORAS: A VALUE DRIVEN SOLUTION FOR COMMUNITY HEALTH Cynthia Alvillar Vision y Compromiso Annual Conference Ontario, California October 29, 2016 Why ROI? Why are we looking at ROI? What is the impetus for measuring ROI? Until now there has not been massive research on ROI, yet there have been important pro-CHW decisions without it Some wish to measure and manage their core health-related value/sustainability goals. Some argue that in some cases demonstrating improved health outcomes alone is not sufficient in order to sustain programs. Some have found that a positive ROI is also necessary to continue when grant funding comes to an end. Why ROI? The Center for Medicare and Medicaid Innovation Models, which encourages the use of CHWs, requires its grant recipients to show cost savings and analysis of returns on investment. Why ROI? “Triple Aim” Improving patient experience and care (quality and satisfaction) Improving the health of populations Reducing the per capita cost of health care What is your experience Are you feeling compelled to measure ROI? Is it something you feel comfortable doing? Are you eager to show the cost savings? Standards, Metrics, and Documentation Documentation of CHW activity has not been a high priority Historically separate from medical records Lack of common metrics has hampered pooling and comparison of data No coherent research strategy exists Example: Center for Medicare and Medicaid Innovation (CMMI) Grants Increasing recognition of beneficial CHW roles in research Value of CHW observations for clinicians is being recognized Adapting to the CHW workforce: Equipping CHW’s to document and report appropriately User-friendly documentation tools for field work Standards, Metrics, and Documentation or Is ROI the only or best measure? There is a difference between activity and volume based billing and a outcome and value based system. The latter is more conducive to the sustainability of the CHW role because improving outcomes are seen as cost reduction. Are there alternatives to a quantitative measure (cultures of health, improved outcomes, healthier communities)? Carl Rush points out that “As long as hospitals are paid for units of service (days of inpatient stay and procedures performed) hospitals are not interested in ROI in terms of CHWs reducing avoidable hospitalizations except for uncompensated care.” The “is it cost-effective” question reflects a limited understanding of CHW roles and capabilities by those that think of personnel as either clinical or administrative. CHW are neither. What is ROI? It is a ratio