Community Asthma Initiative: Cost Analyses using Claims Data from a Medicaid Managed Care Organization.

Objective: Use claims data to examine the cost benefit of the Community Asthma Initiative (CAI), a Boston area nurse-supervised community health worker (CHW) asthma home-visiting program. Methods: The reduction in asthma treatment costs was assessed using Massachusetts claims data from one Medicaid Managed Care Organization (MCO) in the north east that included all costs between January 1, 2011 and December 31, 2016. The data was used to determine asthma-related utilization cost reductions between 1 year pre- and 1, 2 and 3 years post-intervention. The cost reductions for 45 CAI patients and 45 cost-matched comparison patients were measured. Return on investment (ROI) was computed as the difference in cost reduction for CAI patients and a cost-matched comparison population divided by CAI program cost. Results: The excess reduction in per patient asthma-related utilization costs among CAI patients compared to the comparison population was $806 (p = 0.047), $1,253 (p = 0.01) and $1,549 (p = 0.005) between 1 year pre- and 1, 2 and 3 years post-intervention. These yielded adjusted ROI's of 0.31, 0.78 and 1.37 after 1, 2 and 3 years post-CAI intervention. Conclusions: The reduction in asthma utilization costs of a home visit program by nurse-supervised CHWs exceeds program costs. The findings support the business case for the provision of secondary prevention of home-based asthma services through reimbursement from payers or integration into Accountable Care Organizations (ACOs).

An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass.

Abdominal CT (abdCT) scans are frequently ordered for Roux-en-Y gastric bypass (RYGB) patients presenting to the emergency department (ED) with abdominal pain, but often do not reveal intra-abdominal pathology. We aimed to develop an algorithm for rational ordering of abdCTs. We retrospectively reviewed our institution's RYGB patients presenting acutely with abdominal pain, documenting clinical and laboratory data, and scan results. Associations of clinical parameters to abdCT results were examined for outcome predictors. Of 1643 RYGB patients who had surgery between 2005 and 2015, 355 underwent 387 abdCT scans. Based on abdCT, 48 (12 %) patients required surgery and 86 (22 %) another intervention. No clinical or laboratory parameter predicted imaging results. Imaging decisions for RYGB patients do not appear to be amenable to a simple algorithm, and patient work-up should be based on astute clinical judgment.