Building the Business Case for Arthritis Evidence-based Interventions

1. Building the Business Case for Arthritis Evidence-based Interventions 11th Annual Arthritis Grantees Meeting July 2010 Denise Cyzman, MS, RD National Association of Chronic Disease Directors 1

2. Building the Business Case for Arthritis Evidence-based Interventions This workshop and related materials were adapted from the NACDD Building the Business Case for Chronic Disease Prevention and Control course. Information on this course is available at www.chronicdisease.org 2

3. Workshop Objectives • Articulate 5 ways to demonstrate program value • Identify the components necessary for building the business case for evidence-based programs • Understand how to effectively engage stakeholders with the business case • Draft an issue brief demonstrating program value for a specific stakeholder group 3

4. Welcome and Introductions • Your name • Where you work and what you do • One thing you would like to gain from the workshop 4

5. Agenda 5

6. Ground Rules • Be prompt. • Participate. • Use the Bike Rack. • Cell phone, Blackberry, i-Phone, etc. off or on silent mode. • Be open to learning from other participants. • Take what you are learning back to the job. 6

7. Imagine for a moment… 7

8. What is a Business Case? • “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 avoidable costs.” 8

9. What is a Business Case? Definition continued… “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. “ Source: Leatherman, et. al, Health Affairs, March/April 2003 9

10. Why Build a Business Case? • To educate decision-makers about: • the scope and cost of arthritis and its effect on them and their organization. • evidence-based solutions to address arthritis. • how much the solutions will cost and the value they will have to them and their organization – now and in the long run. 10

11. Challenges What are some of the challenges we encounter in building the business case for arthritis (or other) programs? 11

12. Challenges to Building the Business Case • Lack of expertise • Social value of our programs vs. the economic value • Difficult to attain some data • Complex to attach a value to outcomes, such as lives saved or improved quality of life 12

13. Multi-faceted Perspective Source: Kilpatrick and Brownson, Building the Business Case for Diabetes Self-Management, 2008. 13

14. Steps in the Process Identify the right audience(s) Raise awareness of the need Describe the problem Describe the solution and how to get it Show the value of investing in the solution Communicate key messages Evaluate communication effort 14

15. Creating Communication Tools • Identify and understand key messages • Make it brief • Bring your message to the forefront • Turn data into information • Don’t use jargon and acronyms • Use strategic methods • Communication is a relationship, not a one-time event 15

16. Communication Tools • Issue brief and white paper • Meeting • Presentation • Fact sheet and brochure • Proposal • Media 16

17. The Issue Brief • Short neutral summary of issue or problem and solutions • Widely used in government and industry • Distils information into key messages 17

18. Issue Brief Exercise • Worksheet 1 • Divide into small groups. • Take 5 minutes to read the brief. • Identify a reporter for your group. • Discuss the questions in your groups. • One person records answers • 15 minutes • Reporters present to large group. 18

19. Problem What does it cost us? What is the problem? Who is affected? Are there solutions? How many are affected? How good is the evidence? How big is it? What do they cost? Are they worth the cost? Do they work? Solution A Mosaic of Case-Building 19

20. Demonstrating the Problem • Mortality • Morbidity • Disability • Health Related Quality of Life • Costs 20

21. Mortality • How many people died of a certain disease • Time-specific • Shows the severity of a problem • May not motivate • Under-reported • Not significant impact • Everyone dies from something 21

22. Mortality Examples • Relatively few deaths are directly attributed to arthritis • Could be a contributor • Data indicate... • people with arthritis have a higher mortality rate than the general population. • arthritis is associated with a 5 to 15-year reduction in life expectancy. 22

23. Morbidity: Incidence & Prevalence • Incidence: How many people were newly diagnosed within a specific period of time? • Prevalence: How many people have this disease at a certain point in time? 23

24. Incidence and Prevalence Examples • 46.4 million (21.4%) of adult US population report doctor-diagnosed arthritis (2003-2005 data). • Prevalence is expected to increase to 67 million (25%) by 2030. 24

25. Disability • Pain and discomfort • Activity, work and social/role limitations • Psychological distress 25

26. Disability Examples Arthritis tops the list of the most common causes of disability in the United States. • Nationally, 8.8% or 18.9 million people report arthritis-attributed activity limitations (NHIS 2003-2005) • 31% (8.3 million) of working-aged people with arthritis report being limited in work due to arthritis (NHIS 2002) 26

27. Health-related Quality of Life • Looks at quantity and quality of life • Quality Adjusted Life Years (QALY) • Life of year adjusted for its quality • Measured between 0 (death) and 1 (perfect health) • Disability Adjusted Life Years (DALY) • Based on time lived with disability and time lost to premature morbidity • Measured between 0 (perfect health) and 1(death) 27

28. QALY/DALY Data Examples • Studies have reported... • Obese people with knee osteoarthritis had a quality-adjusted life expectancy of 8.35 years vs. 10.57. • Osteoarthritis was a leading source of premature disability, as measured by DALY’s, ranking 12th for men and 7th for women in 1996. 28

29. Healthcare Costs • Associated with providing healthcare services • Ambulatory care • Emergency Department (ED) visits • Inpatient care • Prescriptions • Long-term care • Payers: federal and state government, health insurance companies, businesses, or individuals and their families 29

30. Healthcare Costs Examples • In 2003, direct health care costs for arthritis and other rheumatic conditions (AORC) was $80.8 billion • Average per person direct cost - $1,752 • Highest per-person costs • Ambulatory care - $914 • ED and inpatient services - $352 • Prescriptions - $338 Source : “National and State Medical Expenditures and Lost Earnings Attributable to Arthritis and Other Rheumatic Conditions – United States, 2003.” MMWR 2007;56(01):4-7 30

31. Other Costs • Healthcare costs are only part of the financial burden • Other costs: absenteeism, presenteeism, losses in productivity (quantity and quality) • Opportunity costs: what might have been done if not for the illness? 31

32. Other Costs Examples • In 2003, indirect costs attributable to AORC were $47.0 billion • Average per person lost earnings - $1,590 • Conservative estimate -- doesn’t include cost attributed to loss of homemaking functions • Combining direct and indirect costs, the total cost of in 2003 was $128 billion. 32

33. Demonstrating the Problem • Mortality • Morbidity • Disability • Health Related Quality of Life • Costs 33

34. Identifying Solutions • Evidence-based • Effective • Promising • Emerging Source: Brownson, et. al. Evidence-based public health: A fundamental concept for public health practice. Annual Review of Public Health, 2009, vol.30 34

35. Finding the Evidence • Scientific literature – use portals, systematic, and narrative reviews • Cochrane reviews and Institute of Medicine reports • Guide to Community Preventive Services • Guide to Clinical Preventive Services • Cancer Control P.L.A.N.E.T. • D.E.B.I. (Dissemination of Evidence-based Interventions) • NIH – CRISP • http://www.cdc.gov/arthritis/interventions.htm. 35

36. Demonstrating Value: Business Case Perspectives Demonstrating Value 36 NACDD Building the Business Case for Arthritis Evidence-based Interventions

37. Financial Perspective • Cost analysis • Cost effective analysis • Cost utility analysis • Return on investment or cost benefit analysis 37

38. Cost Analysis Example • Cost of arthritis: $128 billion annually (direct & indirect) • Cost of recommended arthritis interventions: • Start-up costs: $50-$3650 per leader or site • On-going costs: $0-300 per site • Participant materials: $2.30-$30 per participant 38

39. Cost-Effectiveness Example • Chronic Disease Self-Management Program (CDSMP) • Program saved from $390-$520 per patient over 2-year study period • EnhanceFitness (EF) • Average increase in yearly total health costs of participants was $642 vs. $1,175 for non-participants 39

40. Cost-Utility Example • Arthritis Foundation Aquatics Program • Used Quality of Well-Being Scale (QWB) and Current Health Desirability Rating (CHDR) for economic evaluation • Found participants had equal (QWB) or better (CHDR) health-related quality of life compared to controls • Calculated costs/QALY gained at $205,186 using the QWB and $32,643 using the CHDR (discounted at 3%) • Variability of QALY data for the aquatic program 40

41. Return on Investment Example • EnhanceFitness – Kaua’i • Cost:Benefit Ratio of 1:2 • Not specific to Arthritis Evidence-based Interventions • Citibank Health Management Program: $4.7 in benefits for every $1 in costs. • Capital Metropolitan Transit Authority Comprehensive Worksite Wellness Program: ROI was calculated to be $2.43. 41

42. Internal Business Perspective • Translate customer needs and into products • Meet organizational mission and goals • Demonstrate commitment to prevention, self-management, and quality care 42

43. Internal Business Perspective • Example: EnhanceFitness and YMCAs • EF – Group fitness program for older adults • Documented health outcomes • Fewer depressive symptoms • Improved self-rated health • Increased energy and social function • Improved physical fitness • Growing number of YMCAs implementing EF 43

44. Internal Business Perspective • YMCA Mission: promote the development of a healthy spirit, mind and body, by building strong kids, strong families, and strong communities. • YMCA is commitment to address critical social needs and help individuals reach their full potential and every stage of life • EF addresses a need of YMCA “customers” and helps further the organization’s mission. 44

45. Regulatory Perspective • Meet state or federal regulatory requirements • Conditions for reimbursement from 3rd party payers 45

46. Regulatory Perspective • Living Well with Chronic Disease, Oregon • Chronic Disease Self-Management Education • Tomando Control de su Salud 46

47. Community Perspective • Shape organizational image in community • Maximize competitive edge • Long-term survivability • Create image of a quality provider • Meet accreditation standards • Enhance community welfare as a whole 47

48. Community Perspective • Emblem Health, New York • Arthritis Foundation Self-Help Course • Arthritis Foundation Exercise Program • Benefits to AF Partners 48

49. Innovation and Learning Perspective • Improvements in processes of care and health outcomes • Improve strategic positioning • Affects on employee satisfaction, absenteeism, and presenteeism 49

50. Innovation and Learning Perspective 50