Association of Medicare Advantage Premiums With Measures of Quality and Patient Experience.

Importance: Quality of care varies substantially across Medicare Advantage plans. The price information that Medicare Advantage enrollees are most likely to consider when selecting a Medicare Advantage plan is the monthly premium. Enrollees may select plans to minimize premium or, alternatively, use premium as a proxy for quality and select plans with higher premiums; however, quality implications of these choices are unknown. Objective: To determine the extent to which the quality of care offered by Medicare Advantage plans varies within vs across premium levels. Design, Setting, and Participants: This was a retrospective cross-sectional study of the population enrolled in Medicare Advantage plans in 2016 to 2017 using clinical quality measures from the Healthcare Effectiveness Data and Information Set (HEDIS), patient experience measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, and administrative data. Data were analyzed from March 2021 to March 2022. Exposures: Medicare Advantage monthly premium. Main Outcomes and Measures: Ten publicly reported 2017 HEDIS measures and 5 publicly reported 2017 CAHPS measures linearly transformed to a 0 to 100 scale. Results: The 168 968 Medicare Advantage CAHPS respondents were representative of the enrollee population (14% were <65 years old and eligible through disability; 24% ≥80 years old; sex and race/ethnicity data were not considered); 40% were in 591 plans with no monthly premiums and less than 6% were in 144 plans with monthly premiums of $120 or more. There were from 77 054 to 2 139 422 enrollees by HEDIS measure. Among all Medicare Advantage enrollees, 79% were in plans with either a $0 premium or a low monthly premium (≤$60); patient experience and clinical quality were generally similar in these 2 categories of plans. To a small extent, enrollees in moderately high ($60-$120) and high (≥$120) premium plans reported better patient experience (+1.4 [95% CI, 0.7-2.1] and 2.2 [95% CI, 1.5-2.9] points) and received better clinical care (1.4 [95% CI, 0.3-2.5] to 3.3 [5% CI, 2.1-4.5] percentage points on most measures than those with $0 and low-premium plans. Quality differences within each premium level category were substantial; the within-premium category plan-level SDs were 6.5 points and 7.2 percentage points for patient experience and clinical quality, respectively. A plan at the 50th percentile of clinical quality and patient experience in the high premium category would fall in the 65th and 62nd percentile within the $0-premium category, respectively. Conclusions and Relevance: This population-based cross-sectional study found that although quality of care and patient experience were slightly higher with higher-premium plans, quality varied widely within each premium category. High-quality care and patient experience were found in each price category. Thus, paying higher premiums is not necessary for higher quality care in Medicare Advantage plans. Greater engagement of enrollees and advocates with quality of care and patient experience information for Medicare Advantage plan selection is recommended.

Do Financial Incentives Affect Utilization for Chronically Ill Medicare Beneficiaries?

OBJECTIVE: The objective of this study was to examine the price sensitivity for provider visits among Medicare Advantage beneficiaries. DATA SOURCES: We used Medicare Advantage encounter data from 2014 to 2017 accessed as part of an evaluation for the Center for Medicare & Medicaid Innovation. STUDY DESIGN: We analyzed the effect of cost-sharing on the utilization of 2 outcome categories: number of visits (specialist and primary care) and the probability of any visit (specialist and primary care). Our main independent variable was the size of the copayment for the visit, which we regressed on the outcomes with several beneficiary-level and plan-level control variables. DATA COLLECTION/EXTRACTION METHODS: We included beneficiaries with at least 1 of 4 specific chronic conditions and matched comparison beneficiaries. We did not require beneficiaries to be continuously enrolled from 2014 to 2017, but we required a full year of data for each year they were observed. This resulted in 371,140 beneficiary-year observations. PRINCIPAL FINDINGS: Copay reductions were associated with increases in utilization, although the changes were small, with elasticities <-0.2. We also found evidence of substitution effects between primary care provider (PCP) and specialist visits, particularly cardiology and endocrinology. When PCP copays declined, visits to these specialists also declined. CONCLUSIONS: We find that individuals with chronic conditions respond to changes in copays, although these responses are small. Reductions in PCP copays lead to reduced use of some specialists, suggesting that lowering PCP copays could be an effective way to reduce the use of specialist care, a desirable outcome if specialists are overused.

Insurers' perspectives on MA value-based insurance design model.

OBJECTIVES: Value-based insurance design (VBID) lowers cost sharing for high-value healthcare services that are clinically beneficial to patients with certain conditions. In 2017, the Center for Medicare and Medicaid Innovation began a voluntary VBID model test in Medicare Advantage (MA). This article describes insurers' perspectives on the MA VBID model, explores perceived barriers to joining this model, and describes ways to address participation barriers. STUDY DESIGN: A descriptive, qualitative study. METHODS: In spring/summer 2017, we conducted semistructured interviews with 24 representatives of 10 nonparticipating MA insurers to learn why they did not join the model test. We interviewed 73 representatives of 8 VBID-participating insurers about their participation decisions and implementation experiences. All interview data were analyzed thematically. RESULTS: Fewer than 30% of eligible insurers participated in the first 2 years of the model test. The main barriers to entry were a perceived lack of information on VBID in MA, an expectation of low return on investment, concerns over administrative and information technology (IT) hurdles, and model design parameters. Most VBID participants encountered administrative and IT hurdles but overcame them. CMS made changes to the model parameters to increase the uptake. CONCLUSIONS: The model uptake was low, and implementation challenges and concerns over VBID effectiveness in the Medicare population were important factors in participation decisions. To increase uptake, CMS could consider providing in-kind implementation assistance to model participants. Nonparticipants may want to incorporate lessons learned from current participants, and insurers should engage their IT departments/vendors early on.

Patient Experiences with Chronic Care Management Services and Fees: a Qualitative Study.

BACKGROUND: As of 2015, the Centers for Medicare & Medicaid Services (CMS) pays for chronic care management (CCM) services for Medicare beneficiaries with two or more chronic conditions. CMS requires eligible providers to first obtain patients' verbal (and, prior to 2017, written) consent, to ensure that patients who participate in CCM services understand their rights and agree to any applicable cost sharing. CCM providers must also enhance patients' access to continuous and coordinated care, including ongoing care management. OBJECTIVE: To understand patients' perceptions of the consent process, their reasons for choosing to participate, and their experiences receiving CCM services. DESIGN: Qualitative study using semi-structured interviews with Medicare beneficiaries who had two or more CCM claims submitted by an eligible provider. Beneficiaries were selected from a sampling frame of Medicare claims submitted between January and September 2015. KEY RESULTS: Most patients reported no concerns about being asked to participate in CCM. The majority of patients had secondary insurance (or Medicaid) that covered any coinsurance for CCM and therefore could not say with certainty whether they would participate if they had to pay for CCM services out-of-pocket. Reasons for participating included having insurance that covered the copay and peace of mind about having access to the CCM team. Patients reported multiple benefits of participating in CCM services, including better access to their primary care team, improved continuity of care, and improved care coordination. Most patients reported no downside to participating in CCM services, although some felt they were relatively healthy and questioned whether they needed CCM services. CONCLUSIONS: These findings on patients' experiences participating in CCM services during the first 9 months of the policy's implementation can help providers and policymakers understand their perceived benefits and unintended consequences. Our findings also have implications for providers when approaching patients about CCM services.

Multifunctional Sensor Based on Porous Carbon Derived from Metal-Organic Frameworks for Real Time Health Monitoring.

Flexible and sensitive sensors that can detect external stimuli such as pressure, temperature, and strain are essential components for applications in health diagnosis and artificial intelligence. Multifunctional sensors with the capabilities of sensing pressure and temperature simultaneously are highly desirable for health monitoring. Here, we have successfully fabricated a flexible and simply structured bimodal sensor based on metal-organic frameworks (MOFs) derived porous carbon (PC) and polydimethylsiloxane (PDMS) composite. Attributed to the porous structure of PC/PDMS composite, the fabricated sensor exhibits high sensitivity (15.63 kPa-1), fast response time (<65 ms), and high durability (∼2000 cycles) for pressure sensing. Additionally, its application in detecting human motions such as subtle wrist pulses in real time has been demonstrated. Furthermore, the as-prepared device based on the PC/PDMS composite exhibits a good sensitivity (>0.11 °C-1) and fast response time (∼100 ms), indicating its potential application in sensing temperature. All of these capabilities indicate its great potential in the applications of health monitoring and artificial skin for artificial intelligence system.

Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

BACKGROUND: Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. OBJECTIVE: To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. DESIGN: Semi-structured telephone interviews from January to April 2016 with 71 respondents. PARTICIPANTS: Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. KEY RESULTS: Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices. CONCLUSIONS: Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients.

Advice to Quit Smoking and Ratings of Health Care among Medicare Beneficiaries Aged 65.

OBJECTIVE: To examine the relationship between physician advice to quit smoking and patient care experiences. DATA SOURCE: The 2012 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. STUDY DESIGN: Fixed-effects linear regression models were used to analyze cross-sectional survey data, which included a nationally representative sample of 26,432 smokers aged 65+. PRINCIPAL FINDINGS: Eleven of 12 patient experience measures were significantly more positive among smokers who were always advised to quit smoking than those advised to quit less frequently. There was an attenuated but still significant and positive association of advice to quit smoking with both physician rating and physician communication, after controlling for other measures of care experiences. CONCLUSIONS: Physician-provided cessation advice was associated with more positive patient assessments of their physicians.

In vitro assessment of a calcium-fluoroaluminosilicate glass-based desensitizer for the prevention of root surface demineralization.

The purpose of this study was to evaluate the ability of a calcium-fluoroaluminosilicate glass-based desensitizer (Nanoseal) to protect against root demineralization in vitro. Nanoseal was applied to human root dentin, which was immersed in acidic buffer for 72 h, or exposed to pH cycling by immersing in distilled water or mineralizing solution for 24 h intermediately during 48 h-acid attack. Demineralization was evaluated by µ-CT, and mineral loss (ML) and lesion depth (LD) were determined from mineral density profiles. ML and LD in all treatment groups were significantly smaller compared with control. The Nanoseal-treated group with pH cycling using mineralizing solution had the lowest ML and LD. Analysis using an EPMA demonstrated calcium and phosphorous were incorporated into the superficial layer of specimens in the Nanoseal-treated groups, suggesting Nanoseal modified the dentin surface, making it resistant to demineralization. Application of Nanoseal is an effective method for protecting root from demineralization.

Clinician advice to quit smoking among seniors.

OBJECTIVE: Little smoking research in the past 20years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics. METHOD: In 2012-4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 (n=346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation. RESULTS: 12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65-69, 3% of 85+) and education (12-15% with no high school degree, 5-6% with BA+). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African-American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice "always" or "usually" at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p<0.05. CONCLUSIONS: Smoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians.

Changes in state policies related to oral health in the United States, 2002-2009.

OBJECTIVES: Examining state policies in oral health, including changes over time, helps inform the degree to which states fulfill public health dentistry functions and deliver essential services. This study examines changes in state policies affecting oral health in the United States between 2002 and 2009. METHODS: We reviewed 43 oral health policies in three domains (public dental insurance; workforce capacity; and infrastructure, programs, and surveillance). Data sources included federal, state, and private foundation reports and databases. Fifteen of 43 policies had data available for both time points and were analyzed. We examined national and regional changes over time using McNemar's test and Wilcoxon matched pairs signed ranks test. RESULTS: Between 2002 and 2009, the number of states offering Medicaid reimbursement to nondental professionals increased, more states had 12-month continuous coverage in CHIP, income eligibility for children on Medicaid expanded, and the number of licensed dentists per 10,000 population per state increased. However, the percent of public and private state health expenditures going toward dental services declined. Though nationally no other state policies significantly changed, the proportion of population on public water system with fluoridated water increased in Western states, and administration of needs assessments or oral health surveys decreased in the Northeast. CONCLUSION: Efforts are needed to systematically track the status of state policies to promote the public's oral health. Further research can determine if changes in state policies have led to improvements in the provision of oral health services and oral health status and reductions in disparities.

Visible paper chip immunoassay for rapid determination of bacteria in water distribution system.

Paper chips for immunoassay were patterned by screen printing of polydimethylsiloxane (PDMS) or wax pencil drawing. The methods for paper chip patterning are cheap, convenient, rapid and suitable for most laboratories. The whole time for patterning a paper chip is no more than 10 min. Visible immunoassay for the detection of bacteria (Escherichia coli ) has been realized using the paper chip, on which the antibody for capturing E. Coli was immobilized on the detection zones of the paper chip, while the detection antibody was labeled with gold nanoparticles (AuNPs) as a signal reporter. After an immunological reaction, the AuNPs bound on the paper chip can effectively catalyse the reduction of silver ions during the silver enhancing step, generating a visible result that can be read by naked eyes. The quantitative results can be acquired by scanning the silver stained paper chip with a commercial scanner/or digital camera. The density of E. coli in water samples can be measured after calibrating the gray value of silver stained spots with the logarithmic number of bacteria. The time and reagents consumed on the paper chip immunoassay is much smaller than those of conventional ELISA, while the sensitivity of the paper chip immunoassay is comparable to conventional ELISA. The technology proposed in this work displays a great potential in the in-situ analysis when daily monitoring of water quality are required.

Dynamic changes of spatial functional network connectivity in healthy individuals and schizophrenia patients using independent vector analysis.

Recent work on both task-induced and resting-state functional magnetic resonance imaging (fMRI) data suggests that functional connectivity may fluctuate, rather than being stationary during an entire scan. Most dynamic studies are based on second-order statistics between fMRI time series or time courses derived from blind source separation, e.g., independent component analysis (ICA), to investigate changes of temporal interactions among brain regions. However, fluctuations related to spatial components over time are of interest as well. In this paper, we examine higher-order statistical dependence between pairs of spatial components, which we define as spatial functional network connectivity (sFNC), and changes of sFNC across a resting-state scan. We extract time-varying components from healthy controls and patients with schizophrenia to represent brain networks using independent vector analysis (IVA), which is an extension of ICA to multiple data sets and enables one to capture spatial variations. Based on mutual information among IVA components, we perform statistical analysis and Markov modeling to quantify the changes in spatial connectivity. Our experimental results suggest significantly more fluctuations in patient group and show that patients with schizophrenia have more variable patterns of spatial concordance primarily between the frontoparietal, cerebellar and temporal lobe regions. This study extends upon earlier studies showing temporal connectivity differences in similar areas on average by providing evidence that the dynamic spatial interplay between these regions is also impacted by schizophrenia.

Changes in children's oral health status and receipt of preventive dental visits, United States, 2003-2011/2012.

INTRODUCTION: Oral health represents the largest unmet health care need for children, and geographic variations in children's receipt of oral health services have been noted. However, children's oral health outcomes have not been systematically evaluated over time and across states. This study examined changes in parent-reported children's oral health status and receipt of preventive dental visits in 50 states and the District of Columbia. METHODS: We used data from the 2003 and the 2011/2012 National Survey of Children's Health. National and state-level estimates of the adjusted prevalence of oral health status and preventive dental visits were calculated and changes over time examined. Multivariable logistic regression was used to compare outcomes across all states and the District of Columbia for each survey year. RESULTS: The percentage of parents who reported that their children had excellent or very good oral health increased from 67.7% in 2003 to 71.9% in 2011/2012. Parents who reported that their children had preventive dental visits increased from 71.5% in 2003 to 77.0% in 2011/2012. The prevalence of children with excellent or very good oral health status increased in 26 states, and the prevalence of children who received at least 1 preventive care dental visit increased in 45 states. In both years, there was more variation among states for preventive dental visits than for oral health status. CONCLUSIONS: State variation in oral health status and receipt of preventive dental services remained after adjusting for demographic characteristics. Understanding these differences is critical to addressing the most common chronic disease of childhood and achieving the oral health objectives of Healthy People 2020.

Identifying patient, community and program specific barriers to free specialty care utilization by uninsured patients in East Baltimore.

Uninsured individuals face multiple barriers to accessing specialty care. The Access Partnership (TAP) offers free specialty care and care coordination to qualified uninsured patients at an urban academic medical center for a small program entry fee (waived for financial hardship). In the program's first year, 104 eligible patients (31%) did not enroll. To understand why, we investigated demographic, referral, personal, and program-specific factors. After adjusting for age, gender, and ZIP code, diagnostic and therapeutic referrals were more likely to be completed than ancillary referrals (OR=8.56, p=.001; OR 3.53, p=.03). There was no difference between pain related and ancillary referrals (OR=2.80, p=.139). Eighteen patients were surveyed and reported program and patient-specific barriers. While removing costs is necessary to improve access to specialty care for underserved patients, it is insufficient. Improving communication from program coordinators and enrollment strategies may help to improve utilization of free care programs by the uninsured.

Does access to comprehensive outpatient care alter patterns of emergency department utilization among uninsured patients in East Baltimore?

BACKGROUND: The annual number of emergency department (ED) visits in the United States increased 23% between 1997 and 2007. The uninsured and those with chronic medical conditions are high users of emergency care. OBJECTIVE: We sought to determine whether access to comprehensive outpatient primary and specialty care and care coordination provided by The Access Partnership (TAP) reduced ED utilization among uninsured patients relative to patients who chose not to enroll. METHODS: Multiple time series analysis was performed to examine rates of ED utilization and inpatient admission among TAP patients and a comparison group of eligible patients who did not join (non-TAP patients). Monthly ED utilization and inpatient admission rates for both groups were examined prior to and subsequent to referral to TAP, within a study period 2007-2011. RESULTS: During the study period, 623 patients were eligible to enroll, and 374 joined the program. Rates of ED visits per month increased in both groups. Compared with non-TAP patients, TAP patients had 2.0 fewer ED visits not leading to admission per 100 patient-months post-TAP (P = .03, 95% confidence interval = 0.2-3.9). TAP status was a moderate predictor of ED visits not leading to admission, after controlling for age, gender, and zip code (P = .04, 95% confidence interval = 0.1-3.9). CONCLUSIONS: Although overall ED utilization did not change significantly between program participants and nonparticipants, TAP patients had a lower rate of ED visits not resulting in inpatient admission relative to the comparison group.

Assessment of bactericidal effects of quaternary ammonium-based antibacterial monomers in combination with colloidal platinum nanoparticles.

Pretreatment of dentin using colloidal platinum nanoparticles (CPtN) can enhance the bond strength of dentin adhesives. However, the combination of CPtN, which is negatively charged, with cationic monomer-containing adhesive may reduce the antibacterial activity of the original material. Thus, the purpose of this study was to assess the effect of CPtN on the bactericidal activity of two cationic antibacterial monomers, 12-methacryloyloxydodecylpyridinium bromide (MDPB) and methacryloxylethyl cetyl dimethyl ammonium chloride (DMAE-CB). The rapid killing effects of the two monomers against planktonic or attached Streptococcus mutans in the presence or absence of CPtN were examined by viable cell counts. The measurement of minimum inhibitory and bactericidal concentrations demonstrated that CPtN up to 2.5 mM has no antibacterial activity. In the absence of CPtN, rapid killing of both planktonic and attached Streptococcus mutans were achieved by the two cationic monomers. Combination with 0.1 mM CPtN did not reduce the bactericidal effects of the two monomers, indicating that CPtN may be used as a pretreatment with antibacterial adhesives.

Racial disparities in medical expenditures within body weight categories.

BACKGROUND: Despite federal guidelines calling for the reduction of obesity and elimination of health disparities, black-white differences in obesity prevalence and in medical expenditures and utilization of health care services persist. OBJECTIVES: To examine black-white differences in medical expenditures and utilization of health care services (office-based visits, hospital outpatient visits, ER visits, inpatient stays and prescription medication) within body weight categories. STUDY DESIGN: This study used data from the 2006 Medical Expenditures Panel Survey (MEPS) and included 15,164 non-Hispanic white and non-Hispanic black adults. We used a standard two-part econometric model to examine black-white differences in how expenditures (total annual medical expenditures and expenditures for each type of service) vary within body weight categories. KEY RESULTS: Blacks in each weight category were less likely to use any medical care than their white counterparts, even after controlling for socio-demographic characteristics, perceived health status, health conditions and health beliefs. Among those who received medical care, there is no significant difference in the total amount spent on care between blacks and whites. Compared to whites, blacks in each body weight category were significantly less likely to use office-based visits, hospital outpatient visits, and medications. Among those who used medications, blacks had significantly lower expenditures than whites. Blacks in obese class II/III were significantly less likely to have any medical expenditures on inpatient care than their white counterparts. CONCLUSIONS: Black-white racial differences in total medical expenditures were observed in each body weight category and were significantly different in the obese I class, overweight, and healthy weight categories. Obese blacks also spent a smaller amount than obese whites--the insignificance might be due to the smaller sample size. These differences cannot be fully explained by socio-demographics, health conditions, or health beliefs. Black-white differences in medical expenditures may be largely due to relatively inexpensive types of care (office-based visits, outpatient care, medication) rather than more costly ones (inpatient care, ER).

Improving access to care for uninsured patients at an academic medical center: The Access Partnership.

Uninsured individuals face great challenges in accessing both primary and specialty care. The Access Partnership (TAP) is a novel collaboration between primary and specialty care providers at an urban academic medical center to provide care coordination and facilitate access to specialty services for uninsured patients. We reviewed administrative data and performed phone surveys of the 213 patients who entered the program over a one-year period. Specialty care visit attendance was analyzed from administrative data for these patients. We then surveyed patients by phone (60% response rate). Patient-reported access to care and satisfaction with care were significantly higher after TAP (33% vs. 87%, p<0.001 and 41% vs. 91%, p<0.001, respectively). 89% of referrals were completed within 90 days among TAP patients, a rate similar to studies involving insured patients. TAP enrollment was associated with significantly decreased patient-reported barriers to specialty care as well as improved access to and satisfaction with care.

A simulation of affordability and effectiveness of childhood obesity interventions.

OBJECTIVE: This study seeks to project at what level of effectiveness and cost a population-based or targeted intervention would yield a positive net economic benefit. METHODS: Data sources include prevalence of obesity at all ages from the National Health and Nutrition Examination Survey, the persistence of obesity from childhood to adulthood from a literature review, and a cost estimate from the 2006 Medical Expenditures Panel Survey. Econometric analysis was used to estimate medical cost related to obesity. Lifetime medical cost related to obesity is calculated by race, gender, and smoking status. Simulations were conducted to estimate the break-even point for interventions that take place between ages 0 and 6 years, ages 7 and 12 years, and ages 13 to 18 years, with a range of effectiveness. RESULTS: Results of simulations reveal that, from a pure medical cost perspective, spending approximately $1.4 to $1.7 billion at present value for each birth cohort will break even if 1 percentage point reduction in obesity among children is achieved. Population-based interventions can spend up to between $280 and $339 per child at present value if 1 percentage point reduction in obesity rate could be achieved; in contrast, should we invest in interventions that only target obese children, we can spend up to $1648 to $2735 per obese child for every 1 percentage point reduction in obesity rate. CONCLUSIONS: This study has several important policy implications; early interventions make economic sense. Targeted interventions could yield higher cost savings than population-based interventions for young children (aged 0-6 years), whereas a population-based approach could yield greater economic net benefits for adolescents (aged 13-18 years). Our simulation shows that childhood obesity interventions, even with moderate effectiveness, would make economic sense, which should motivate policy makers to take action.