Return on Investment for Healthcare Quality Improvement

ISBN-13: 9783030464806 / Angielski / Miękka / 2021 / 263 str.

Craig A. Solid

Spis treści

Chapter 1. Introduction

1.1 The Current Healthcare Environment

1.1.1 Funding Requirements for Those Looking to Improve Care Quality

1.2 Concepts of Value in Quality Improvement

1.2.1 A Discussion of “Value” in Health Care

1.2.2 The Journey of Understanding Value in Relation to that of Quality

1.3 Quality Improvement as an Exercise in Influence

1.4 Return on Investment

1.4.1 How ROI is Used in Other Industries

1.4.2 How We Will Define ROI

1.4.3 Unique Challenges for Examining ROI in the Healthcare Setting

1.4.4 Differences in Prospective Versus Retrospective Analyses of ROI

1.5 Who this Book Is For

1.6 Chapter Summary

1.7 Key Concepts

References

Chapter 2: Planning an ROI Analysis

2.1 The Motivation to Assess Value in Health Care

2.2 The Critical Aspects of Quality Improvement

2.2.1 Defining Quality

2.2.2 Measuring Quality

2.2.3 Assessing and Evaluating Quality

2.3 Measuring Value

2.3.1 Considering What Can Be Improved, Measured, and Monetized

2.3.2 Planning the Value Assessment in Tandem with the Quality Assessment

2.4 Definitions and Terms

2.4.1 ROI

2.4.2 Benefit-to-Cost Ratio (Benefits per Dollar Spent) 

2.4.3 Savings per Patient

2.4.4 Payback Period

2.4.5 Other Metrics

2.5 Basic ROI Design

2.5.1 Scope and Perspective

2.5.2 Costs and Benefits

2.5.3 Base Case and Sensitivity Analyses

2.5.4 Interpretation

2.6 Hypothetical Case Studies

2.6.1 Example 1: Nursing Home Falls

2.6.2 Example 2: Improved Hospital Discharge Process

2.6.3 Example 3: Introducing a Collaborative Care Model

2.6.4 Example 4: Investing in Facility Improvements

2.7 Chapter Summary

2.8 Key Concepts

References

Chapter 3: Initial Steps

3.1 Define Scope and Perspective

3.1.1 Perspective

3.1.2 Scope

3.1.3 Practical Examples of Defining the Scope and Perspective

3.1.4 Major Assumptions and Their Implications

3.2 Determine What to Measure

3.2.1 Process Versus Outcome Measures

3.2.2 Individual Versus Composite Measures

3.2.3 One Versus Many Measures

3.2.4 The Impact of Project Characteristics on Measures

3.3 How to Select Quality Improvement Opportunities for Value

3.3.1 Questions to Ask

3.4 How to Estimate the Expected Effectiveness and Associated Value

3.4.1 Pulling from Your Own Experience

3.4.2 Pulling from Published Literature

3.5 Secure Buy-In and Recruit Partners

3.6 Chapter Summary

3.7 Key Concepts

Chapter 4: Costs and Benefits

4.1 The Impact of Scope and Perspective on Costs and Benefits

4.2 Costs

4.2.1 Identifying Cost Sources

4.2.2 Estimating and Monetizing Costs

4.2.3 Aggregating Costs

4.3 Benefits

4.3.1 Measurable, Monetizable, and Directly Attributable Benefits

4.3.2 Estimating MMA Benefits

4.3.3 Estimating Non-MMA Benefits

4.3.4 Calculating Benefits (Formulas) 

4.4 Discounting

4.5 Chapter Summary

4.6 Key Concepts

References

Chapter 5: Performing Base Case and Sensitivity Analyses

5.1 Prospective versus Retrospective ROI Analyses

5.2 Developing the Base Case Scenario

5.2.1 General Considerations for the Base Case

5.2.2 Identifying Usable Estimates

5.2.3 Applying the Perspective and Scope to the Base Case

5.2.4 A Base Case Example

5.3 Sensitivity Analysis

5.3.1 General Considerations for the Sensitivity Analysis

5.3.2 Creating Best- and Worst-Case Scenarios

5.3.3 Identifying What to Vary in the Sensitivity Analysis

5.3.4 Adding in Non-MMA Benefits

5.3.5 Adding Other Forms of Value

5.4 Uncertainty and Alternatives

5.4.1 Identifying Key Assumptions

5.4.2 Assessing How Much Key Assumptions Could Vary

5.4.3 Estimating the Potential Impact of Assumptions and Estimates

5.4.4 Exploring Alternatives to Assumptions

5.5 Chapter Summary

5.6 Key Concepts

Chapter 6: Interpretation and Presentation

6.1 Exploring the Background and Project Motivation

6.1.1 Methods for Providing Appropriate Background

6.2 Interpreting ROI Analysis Results

6.2.1 Interpreting ROI Values

6.2.2 Interpreting the Benefit to Cost Ratio (BCR) 

6.2.3 Interpreting the Payback Period

6.2.4 Interpreting Savings per Patient

6.3 Extrapolating and Generalizing Results

6.3.1 Generalizing to Other Settings

6.3.2 Extrapolating the Effect of a Change in Scope

6.3.3 Extrapolating the Effect of the Intensity of the Intervention

6.3.4 Extrapolating to Different Populations

6.4 Developing a Full Report to Present Results

6.4.1 Ensuring the Key Information Is Reported

6.4.2 Effectively Presenting the Essential Information

6.5 Chapter Summary

6.6 Key Concepts

References

Chapter 7: Hypothetical Case Studies

7.1 Example 1: Reducing Nursing Home Falls

7.1.1 Sample ROI Analysis

7.2 Example 2: Improving the Discharge Process

7.2.1 Sample ROI Analysis

7.3 Example 3: Introducing a Collaborative Care Model

7.3.1 Sample ROI Analysis

7.4 Example 4: Investing in Facility Improvements

7.4.1 Sample ROI Analysis

7.5 Comments about the hypothetical examples

Chapter 8: Tips and Templates

8.1 Tips

8.1.1 Accessing Relevant Information

8.1.2 Presenting ROI Results in Oral Presentations

8.1.3 Responding to a Request for Proposals (RFP) 

8.1.4 Publishing and Disseminating Results

8.1.5 Develop a Process

8.1.6 Increasing Influence

8.2 Templates

8.2.1 Literature Abstraction Template

8.2.2 Outline and Checklist Templates

8.2.3 Costs

8.2.4 Benefits

8.2.5 Calculations of Base Case and Sensitivity Analyses

8.3 Chapter Summary

8.4 Key Concepts

Chapter 9: Expanded Topics in ROI

9.1 ROI in a Value-Based Environment

9.1.1 Reducing Encounters Versus More Efficient Encounters

9.1.2 Benefits Across Care Settings

9.1.3 Benefits Associated with Quality Monitoring Programs

9.1.4 The Impact of Social Media

9.1.5 Putting It All Together

9.2 Life Years and Quality-Adjusted Life Years (Cost-Effective and Cost-Utility Analysis) 

9.2.1 Background

9.2.2 Relationship to ROI

9.3 Deterministic and Probabilistic Sensitivity Analysis

9.4 Contingent Valuation

9.5 The Changing Landscape of Quality Improvement

9.5.1 The Evolution of Care Delivery

9.5.2 Implementation Science and Emerging Methodologies

9.5.3 Where Does ROI Fit In? 

9.6 ROI in Statistical Process Control

9.7 Chapter Summary

9.8 Key Concepts

References

Glossary of Terms

O autorze

Craig A. Solid, PhD, is a health services researcher and consultant who is owner and principal of Solid Research Group, LLC. Due to his expertise in the measurement and assessment of healthcare quality and value, and familiarity with federal quality initiatives and the evaluation of health policy and reimbursement, Dr. Solid helps healthcare organizations to navigate the complex world of data and measurement related to healthcare quality and research. His training as a statistician and economist allows him to effectively convey complex analytic and clinical concepts to a variety of audiences. Dr. Solid has given seminars and guest-lectures on analytic methods related to continuous quality improvement (control charting, etc.), the process of calculating the return on investment (ROI) for quality improvement, and the steps required to write and format peer-reviewed manuscripts for journal submission. He has co-authored over 50 peer-reviewed manuscripts and has presented work at numerous national and international conferences.

Blurb

This book offers a comprehensive overview of performing return-on-investment (ROI) analyses for healthcare quality improvement (QI). In the United States, healthcare policy regarding physician and facility payment/reimbursement is steadily trending towards the use of “value-based” systems and away from the traditional “fee-for-service” (FFS) payment mechanisms. Healthcare professionals and organizations who have previously focused on quality metrics are now finding themselves burdened with having to define and assess value metrics, without much guidance or assistance. This volume aims to be a guide and a reference for healthcare professionals tasked with estimating and establishing ROI for QI.

Chapters describe the general framework for how to perform QI; establish standard definitions of important terms, concepts, and calculations; and provide specific instructions for how to complete each step of an ROI analysis. These include: selecting a QI initiative and identifying the associated metrics, establishing measurable, monetizable, and attributable costs and benefits, determining the appropriate scope and perspective, calculating ROI and related metrics (payback period, benefit-to-cost ratio, etc.), comparing with established benchmarks or previously published results, and interpreting the results for the intended audience. In addition, chapters offer examples of real studies (or hypothetical studies of real situations), as well as templates for several of the necessary activities that readers can leverage for their own use.

Return on Investment for Healthcare Quality Improvement is a must-have resource for healthcare providers, administrators, and other professionals who work in healthcare organizations, hospitals and other healthcare settings, health systems, and residency programs seeking to obtain outside funding, as well as policy makers and administrators of federal programs.