The Asthma Return on Investment (ROI) Calculator Web Conference: Questions and Answers

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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.

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Technical Questions

Question: Can the Calculator be modified to obtain return on investment calculations for other diseases?
Answer: The Asthma ROI Calculator only applies to asthma.

Question: Are physician visits to be included in the outpatient visits category?
Answer: Physician visits are included in the outpatient visits category.

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 population database.

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 the literature?
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 going forward?
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 made?
Answer: The AHRQ project team is available to assist you in using the tool, including making sure the appropriate inputs are used.

Current as of May 2009

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