Incremental Cost-Effectiveness of the Champs Intervention As Implemented in Diverse Underserved Communities

Introduction:  A key aim of the CHAMPS study was to apply a cost-effectiveness analysis to assess the benefits of an evidence-based childhood asthma counseling and environmental intervention at FQHCs. Incremental cost-effectiveness ratio (ICER) has rarely been applied in calculating the benefits of asthma management programs.  Additionally, while prior asthma intervention studies collected data on select settings (e.g., the ER), our study collects data directly from health insurers to cover a variety of services and settings using adjudicated payments. 

 

Methods:  We leveraged FQHCs’ established partnerships with local health plans to collect patient information.  We contacted 1 to 4 plans from each state for both cost and utilization data on ER visits, urgent care, inpatient and outpatient care, physician visits, pharmaceuticals, medical devices, and medical tests.  We also performed a literature review, contacted experts, and consulted with FQHC physicians to construct an algorithm for asthma-related medical costs and procedures.  We targeted 300 low-income, underserved pediatric patients with poorly-controlled, moderate-to-severe asthma (150 intervention; 150 comparison) from 6 FQHCs located in 3 states/jurisdictions, representing half of the total study sample.

 

Results:  Engaging health plans in the early planning phases of analysis was successful in ensuring their buy-in and participation. Still, the challenges of working in low-resource settings with low-income populations were evident. Despite using the most complete available information on health utilization and cost, we still identified gaps in data for some patients.  Gaps were mostly due to changing contractual arrangements between state Medicaid agencies and health plans and temporary freezes on enrollment in the state CHIP program.  Other operational challenges included the need to collect data covering both 12 months before and 12 months after enrollment, and the lag-time between submitted and adjudicated claims.  These issues were accounted for to ensure timely data collection and project completion.

 

Conclusion:  ICER has been under-utilized for the evaluation of childhood asthma management programs. By using rigorous data collection protocols and cost data from health insurance plans, we demonstrate how successful implementation of asthma management programs can yield favorable cost/benefit ratios across various jurisdictions. We expect our analysis to inform practitioners and policymakers on the value of interventions like CHAMPS and to promote state policy modifications and reimbursement reforms that support comprehensive coverage of the services, procedures, and items provided under the CHAMPS intervention, including non-medical services with a significant clinical impact, such as providing mattress covers and pillow cases to create a “safe sleeping zone.”