Valuing the Integrated Primary and Mental Health Clinic Project

Valuing the Integrated Primary and Mental Health Clinic Project

Center for Health Care Services (CHCS)

Texas Healthcare Transformation and Quality Improvement Program

(Project Number 11-W-00278/6)

Prepared by:

H. Shelton Brown, Ph.D.

A. Hasanat Alamgir, Ph.D

UT Houston School of Public Health

Thomas Bohman, Ph.D.

UT Austin Center for Social Work Research

The CHCS proposal to co-locate primary care physical health services meets the Delivery System Incentive Reform Payment (DSRIP) Pool 1115(a) waiver component’s Category I Infrastructure development goal. The following valuation is aligned with the Demonstration program goals to develop programs that enhance access to health care, increase the quality of care, the cost-effectiveness of care provided and the health of the patients and families served. The primary valuation method uses cost-utility analysis (a type of cost-effectiveness research) and additional information is reported on potential, future costs saved.

Valuations should be based on economic evaluation principles which identify, measure, and value the relevant costs and consequences of two or more alternatives. Typically, one alternative is a new program while the second is treatment as usual. Cost-utility analysis measures the cost of the program in dollars and the health consequences in utility-weighted units. This valuation uses quality-adjusted life-years (QALYs) which combines health quality (utility) with length of time in a particular health state.

Cost-utility analysis is a useful tool for assessing the value of new health service interventions due to the fact that it provides a standard way of valuing multiple types of interventions and programs. The valuation also incorporates costs averted when known (e.g., emergency room visits that are avoided). In order to make the valuations fair across potentially different types of interventions, the common health goal, or outcome, is the number of life-years added.[i]

The benefits of the proposed co-location program are valued based on assigning a monetary value of $50,000 per life-year gained due to the intervention. This threshold has been a standard way of valuing life-years in terms of whether the cost of the intervention exceeds this standard.

The integrated health-care intervention

The number of life-years added is based on a review of the scientific literature from integrated health care interventions. Because of the relative newness of the integrated health-care intervention, no studies were identified that provided a direct measure of life-years gained in the Tufts University Comparative Effectiveness Analysis Registry. Although the planned intervention is multi-faceted, we examined more specific interventions for primary care. The closest study we identified examined collaborative care intervention for multi-symptom patients including depression (Katon, 2012). In this study, the effect of the intervention was 0.018 incremental life years gained. After quality-adjusting, 0.338 quality-adjusted life-years were added. Assuming the program would serve 150 persons in a year, the following formula shows the total valuation:

500 (persons served) X 0 .338 (incremental quality-adjusted life year gained) x $50,000 (life year value) = $8,450,000

The total valuation for the integrated health service program is $8,450,000.

Cost-savings Research

A recent review found collaborative care models showed medium to high levels of involvement by primary care providers, with regular contact between medical and mental health staff (Druss et al., 2006). Earlier studies study that showed significant improvement in 15 of 17 guideline-recommended preventive activities (Druss et al, 2001) and increased diagnosis rates for four common medical conditions (Weisner et al., 20001). In the Weisner et al. (2001) study, there was a significant decline in annual costs for the subsample of patients with substance-related mental and medical comorbidities, compared to the control group.

For the collaborative care model referred to as patient-centered medical homes, a recent study found positive cost saving for the payor organization (Maeng, 2012). Longer collaborative care was significantly related to lower total cost (Total cumulative cost savings was 7.1%. The return on

investment was 1.7 (or 1.7 dollars saved for each dollar invested).

Summary

This valuation analysis shows that the intervention will have a positive value for participants who receive the intervention resulting in a total valuation of $450,000. In addition, evidence supports the expectation that program implementation will result in long-term cost savings to health care organizations funding these initititaives.

References

H. Shelton Brown III, Adriana Perez, Yen-Peng Li, Deanna Hoelsher, Steve Kelder, and Roberto Rivera. The cost-effectiveness of a school-based overweight program. International Journal of Behavioral Nutrition and Physical Activity, 4(47), October 2007. PMID: 17908315.

Druss BG, Rohrbaugh RM, Levinson CM. et al. Integrated medical care for patients with serious psychiatric illness: a randomized trial.[see comment] Archives of General Psychiatry. 2001 Sep;58(9):861–8.

Katon W, Russo J, Lin EB, et al. (2012). Cost-effectiveness of a Multicondition Collaborative Care Intervention: A Randomized Controlled Trial. Arch Gen Psychiatry. 69(5):506-514.

Maeng, DD, Graham, J, Graf, T, Liberman, JN, Dermes,NB;Tomcavage, J., Davis, DE, Bloom , FJ, & Steele, GD (2012) Reducing Long-Term Cost by Transforming Primary Care: Evidence From Geisinger’s Medical Home Model Am J Manag Care.18(3):149-155

Parthasarathy S, Mertens J, Moore C. et al. Utilization and cost impact of integrating substance abuse treatment and primary care. Medical Care. 2003 Mar;41(3):357–67.

Weisner C, Mertens J, Parthasarathy S. et al. Integrating primary medical care with addiction treatment: a randomized controlled trial.[see comment] JAMA. 2001 Oct 10;286(14):1715–23.

[i]Note that all incremental life-years added are not equal. In some cases, a person may be too limited in terms of physical ability to work, or they may have a disability. Therefore, life years were also adjusted based on self-reported health and activity limitations. For instance, persons with severe obesity will need assistance with daily activities in comparison to healthy people. Therefore, if an intervention adds a year of life for an unhealthy person, it will “count less” than a year added for a healthy person. The scale typically ranges from one for a person with no limitations and excellent health, to nearly zero for a person with significant limitations for activities such as bathing and dressing. For example, Brown et al. (2007) discounted the value of a life-year for an obese person, below one, by approximately 0.06 in comparison to non-obese people (Brown et al. 2007). Where necessary, we may employ this strategy in addition the valuation model incorporated into this proposal.