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Great, we've improved care quality, but how much did it cost?

Cohen AN, Slade E, Hamilton AB, Young AS. Great, we've improved care quality, but how much did it cost? Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.


Objectives: The VHA Blueprint for Excellence reiterates that the VA must maximize health outcomes in a cost-effective manner. EQUIP was a clinic-level controlled trial (8 sites, N = 801 patients with schizophrenia) of an intervention designed to increase utilization and impact of two services: MOVE and Supported Employment. The intervention increased utilization of both services (by 2.3 times, on average) resulting in less weight gain (-12 lbs per individual) but not increased employment, a more distal outcome. This study estimated the average VA cost-consequences and cost-effectiveness of EQUIP, compared to usual care, in achieving improvements in quality-adjusted life years. Methods: We supplemented EQUIP records with data on healthcare utilization and costs. In addition to direct costs, we also examined indirect costs associated with use of other VA outpatient health care services. Indirect costs were examined by comparing use of outpatient mental health, primary care, and rehabilitation services between EQUIP and usual care sites, controlling for spending during the 6-month period prior to EQUIP. Results: The one-time cost of the setting up EQUIP was $14,385 per site. These costs include the effort and salary of the staff who prepared the intervention, marketed the project, and engaged existing services. The average annual cost of delivering EQUIP was $1,075 per patient. In the EQUIP group, VA outpatient health care costs increased by $1,195 per person compared to the 12- month period preceding baseline. By contrast, in the usual care group, outpatient costs increased by $1,810 per person, or by $615 more per person than in EQUIP. Most of these savings were the result of lower utilization in EQUIP of intensive outpatient mental health services. Thus, our estimates suggest that 57% of the $1,075 per person direct cost of EQUIP was offset by lower outpatient costs for other services. EQUIP was not associated with quality-of-life improvements. Implications: As an evidence-based platform for improving care coordination and care quality among Veterans with schizophrenia, EQUIP fosters more efficient use of existing recovery-oriented services and has modest operating costs after it is implemented. Impacts: Utilization and impact of other services that support recovery of this population could be improved with the application of EQUIP.

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