Using the Return on Investment Template
THE BUSINESS CASE FOR QUALITY
IN MEDICAID MANAGED CARE
Using the Return on Investment Template
Developed in collaboration with:
The Center for Health Care Strategies
May 2007
Kristin Reiter, PhD1
Kerry Kilpatrick, PhD1
Sandra Greene, DrPH2,1
Sheila Leatherman, MSW1
1
Department of Health Policy and Administration, University of North Carolina at Chapel
Hill
2
Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC
Acknowledgements
The development of the return on investment template and the related supplemental
instructional manual were supported by a grant from The Commonwealth Fund.
The authors gratefully acknowledge the valuable input of Stephen Somers, Melanie
Bella and Allison Hamblin at the Center for Health Care Strategies, and the excellent
research assistance of Emily Keyes.
2
TABLE OF CONTENTS
Introduction
4
Why Care About the Business Case?
4
What is a Business Case?
4
The Components of the Payer Business Case Analysis
5
Things to Consider Before Undertaking a Business Case Analysis
5
Instructions for Using the Return on Investment Template
7
Proposed Use
7
Design of the ROI Template
7
The Data Entry Spreadsheets
7
Tab 2. Initial Investment Cost Data
7
Tab 3. Operating Cost Data
9
Tab 4. Paid Claims Data ¨C Intervention
9
Tab 5. Paid Claims Data ¨C Control
10
The Output Spreadsheets
10
Tab 6. Paid Claims Data ¨C Incremental
10
Tab 7. Return on Investment Analysis
11
Tab 8. Incremental ROI Analysis
12
References
13
Appendix A ¨C Sample Business Case Analysis
14
3
Using the Return on Investment Template
The purpose of this instructional manual is to introduce the rationale for establishing a business
case for implementing quality enhancing interventions (QEIs) in health care, and to present step
by step instructions for using the return on investment template to collect and display the
required data. The template is intended to provide a general starting point for retrospectively
analyzing the business case; however, no two settings or QEIs are precisely the same.
Therefore, users need to be mindful that some customization of methods may be required in
any application.
INTRODUCTION
Why Care About the Business Case?
1. Absent a convincing business case it is unlikely that quality interventions will be
sustainable over the long run. While commendable, good intentions can only go so far
toward convincing providers (and payers) to adopt QEIs.
2. In cases where an organization has determined that the evidence base warrants the
adoption of a QEI, having information about the business case provides a more
complete picture of the overall consequences of the intervention for the organization.
3. If the ultimate goal is to attempt to align financial incentives to pay for quality,
organizations investing in QEIs need to explicitly measure the costs and savings
attributable to the interventions.
To recognize the importance of having a strong business case, one has only to look at the fact
that deficiencies in the quality of health care remain prevalent despite an increasing body of
evidence to guide the implementation of proven quality interventions [1-3]. Policymakers,
payers, and employers continue to express their frustration that QEIs of demonstrated
effectiveness are not being implemented on a broad basis. Even after decades of careful
evidence-based practice research, one of the principal reasons that hospitals, health care
delivery systems, and individual providers in the United States give for not implementing
promising health care QEIs is that no ¡°business case¡± for quality can be made. Recent case
studies confirmed that, in the absence of a convincing business case, quality interventions have
a low probability of widespread adoption and a lower probability of being sustained over time [4].
What is a Business Case?
The general notions encompassed in the development of a business case for quality are mostly
drawn from non-health care industry. For health care, the recent interest in the business case
was generated by an article in Health Affairs by Leatherman, et al.[4]. There the authors define
the business case (see box below) and provide an analysis of a series of case studies, which
sought to confirm the existence of a business case in a variety of commercial settings.
A business case for a health care improvement intervention exists if the entity that invests in the
intervention realizes a financial return on its investment in a reasonable time frame, using a
reasonable rate of discounting. This may be realized in ¡°bankable dollars¡± (profit), a reduction in
losses for a given program or population, or avoided costs. In addition, a business case may exist if
the investing entity believes that a positive indirect effect on organizational function and sustainability
will accrue within a reasonable time frame.
4
As the definition suggests, a business case may exist even in the absence of a direct financial
return on investment for the organization which implements the intervention. The templates,
however, focus on modeling the financial consequences of a QEI. Thus, users need to consider
other positive effects on the organization that are not quantified in the templates before
concluding that there is no business case for an intervention.
Examples of non-financial benefits include, but are not limited to:
?
?
?
?
?
?
Improved market recognition for quality
Enhanced market share
Improved employee satisfaction/retention
Improved provider satisfaction
Enhanced inspection and/or accreditation status
Fulfillment of mandated requirements, e.g., conditions of participation with state
Medicaid program
Note that the definition of the business case is from the perspective of the ¡°entity that invests in
the intervention.¡± If that entity is a primary care practice, group practice, or health clinic, the
business case (return on investment) is calculated from that perspective. If cost savings or
other benefits accrue to a party (including the patient) other than the one making the
investment, the benefits are not included as part of the business case. In this way, business
case analysis differs substantially from other types of economic analysis (e.g., cost-benefit,
cost-effectiveness, cost-utility) which often measure costs and benefits from a societal
perspective.[5] The perspective of business case analysis is purposely narrow since its primary
goal is to determine the sustainability of QEIs from the investing organization¡¯s perspective. For
QEIs that are cost-effective, business case analysis can help identify financing misalignments
that may serve as barriers to adoption.
The Components of the Payer Business Case Analysis
Basically, to compute a financial business case for quality (measure the return on investment)
for your intervention, you will need estimates of three things:
1. The costs incurred to develop the intervention.
2. The continuing costs of operating the intervention over time.
3. The effect on paid claims, revenues, and other quantifiable financial benefits or costs
that accrue to the organization that implemented the intervention.
Surprisingly, a review of the literature [6] found that organizations frequently were able to report
on the savings or other benefits of a quality intervention, but did not report (and perhaps did not
know) what the intervention cost to develop and to operate over time. The return on investment
template has been developed to assist you in collecting and managing these data.
Things to Consider Before Undertaking a Business Case Analysis
1. The evidence that the QEI improves quality. If you implemented a QEI that clearly did
not achieve your quality goals and would not likely be used again by your organization,
then there is little sense in engaging in an analysis of the return on investment for that
particular QEI.
5
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- 7 return on investment safely
- equipment return on investment template
- return on investment formula
- 4 return on investment guaranteed
- return on investment calculator excel
- return on investment spreadsheet templ
- return on investment template
- return on investment spreadsheet template
- return on investment formula excel
- return on investment worksheet
- calculating return on investment excel
- equipment return on investment calculator