Capital IDEA From Patient to Provider

Transcription

1 Capital IDEA From Patient to Provider Economic Analysis Overview As part of the Delivery-System Reform Incentive Payment (DSRIP) program administered by the Texas Health and Human Services Commission (HHSC), Capital IDEA received funds as a sub-grantee under the City of Austin (COA). Capital IDEA s project, From Patient to Provider supported the training of already-qualified, low-income, primarily minority, and first-generationin-college adult students to become Registered Nurses (RNs). Capital IDEA partnered with Austin Community College (ACC) to expand the Fall 2014 nursing class by 10 students and expand the Spring 2015 nursing class by 15. Capital IDEA also provided wrap-around social services to support the students and increase the likelihood of graduation. As a result of the project, 18 students graduated and became RNs, and ACC permanently increased the number of RNs that it can train by 15 per year. As part of its participation in the DSRIP program, COA chose to complete Stretch Activity 9 (Cost-Benefit Analysis). This document represents the cost-benefit analysis (CBA) for the From Patient to Provider project. Methodology HHSC conveyed a preference for performing providers completing Stretch Activity 9 to use one of several identified ROI/CBA tools. However, because the Patient to Provider project is not a quality-related project, the tools suggested by HHSC are not appropriate. This analysis instead focuses on the General Principles and Considerations, identified by HHSC in its instructions for Stretch Activity 9, to develop and apply a customized ROI/CBA analysis, in particular the following: As noted in the General Principles section of HHSC s directions for Stretch Activity 9: Economic evaluations in healthcare should, where feasible, consider the societal viewpoint. For SA-9, providers should include and savings specific to their organization and other medical providers if that information is available (i.e. avoided emergency department 1

2 utilization). Providers should include the societal viewpoint (i.e. patient time, missed work) if directly tied to your project and if it impacts potential payers. HHSC s directions also indicate: Costs could include, but would not be limited to, associated with ongoing overhead needs, staff/labor, supplies, and equipment. For purposes of this analysis, providers should utilize the ongoing of the intervention, and may or may not include the start-up that are assumed to already be covered by DSRIP payments. Therefore, this analysis focuses on the increase in earnings for the individuals who were supported through the project, using a conservative social discount rate. In addition, the increase in income for individuals not supported through the program but educated to the RN-level based on the marginal increase in ACC s student volume will be included. Ongoing include ACC s ongoing marginal for the marginal increase in student volume. The analysis is done both with and without the direct grant associated with the program. The analysis includes the following assumptions: The total grant award was $656,848. The ACC contract value was $376,290, with spread over three years, based on actual paid amounts by year. Ongoing annual ACC past the project period are equal to the amount received each year of the project. Non-ACC were spread over five years. ACC permanently increased its annual nursing program enrollment by 15. The average annual income of Capital IDEA students prior to participating in the program was $14,000. The average annual income prior to matriculating for non-program participants was $28,000. The average annual income after completing the program was $48,672. 2

3 Results DSRIP-funded and Ongoing Costs (not discounted) Year CI ACC grant ACC admin Total 2014 $56, $47, $181, $56, $188,145 $181, $56, $141, $181, $56, $125,430 $181, $56, $125,430 $181, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125, $125,430 $125,430 Past and Projected Graduates and Income Impact Year Number of graduates in year Total number of graduates Aggregate increase in income 2014 $ $ $277, $624, $934, $1,244, $1,554, $1,864, $2,174, $2,484, $2,794, $3,104, $3,414, $3,724, $4,034,976 3

4 Discounted Costs and Benefits (3% discount rate) Year Total annual Total annual 2014 $181,542 $181, $181,542 $363, $181,542 $544,625 $277,376 $277, $181,542 $726,166 $624,096 $901, $181,542 $907,708 $934,176 $1,835, $121,667 $1,029,375 $1,206,928 $3,042, $118,017 $1,147,392 $1,462,475 $4,505, $114,477 $1,261,869 $1,701,602 $6,206, $111,042 $1,372,911 $1,925,066 $8,131, $107,711 $1,480,622 $2,133,590 $10,265, $104,480 $1,585,102 $2,327,870 $12,593, $101,345 $1,686,447 $2,508,573 $15,101, $98,305 $1,784,752 $2,676,339 $17,778, $95,356 $1,880,108 $2,831,782 $20,609, $92,495 $1,972,603 $2,975,489 $23,585,362 Discounted Costs and Benefits (7% discount rate) Year Total annual Total annual 2014 $181,542 $181, $181,542 $363, $181,542 $544,625 $277,376 $277, $181,542 $726,166 $624,096 $901, $181,542 $907,708 $934,176 $1,835, $116,650 $1,024,358 $1,157,158 $2,992, $108,484 $1,132,842 $1,344,345 $4,337, $100,890 $1,233,733 $1,499,656 $5,836, $93,828 $1,327,561 $1,626,636 $7,463, $87,260 $1,414,821 $1,728,491 $9,191, $81,152 $1,495,973 $1,808,115 $11,000, $75,471 $1,571,444 $1,868,122 $12,868, $70,188 $1,641,633 $1,910,869 $14,779, $65,275 $1,706,908 $1,938,477 $16,717, $60,706 $1,767,614 $1,952,857 $18,670,375 4

5 $25,000,000 Aggregate Net Benefit by Year (with grant ) $20,000,000 $15,000,000 $10,000,000 $5,000,000 $ $5,000,000 Net Benefit (low rate) Net benefit (high rate) $25,000,000 Aggregate Net Benefit by Year (without Grant Costs) $20,000,000 $15,000,000 $10,000,000 $5,000,000 $ Net Benefit (low rate) Net benefit (high rate) 5

6 Measures of Return/Benefit High discount rate, with grant Low discount rate, with grant Low discount rate, without grant High discount rate, without grant ROI 1096% 956% 1693% 1581% Aggregate net benefit Conclusion $21,612,759 $16,902,761 $22,269,607 $17,559,609 The From Patient to Provider project demonstrates positive net aggregate benefit (total aggregate less total aggregate ) beginning in 2018 and increasing consistently thereafter. Within the ten-year time horizon and across all models, annual net benefit rises to over $1.9 million per year with total aggregate net benefit over the 10 years of over $16 million in current dollars, representing a return-on-investment of over 950%. 6