Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120
Presentation
Results from estimating the incremental costs of providing behavioral change services in primary care physician practices
To decide whether a behavioral change treatment or intervention is worth implementing in a medical practice and whether to pay for it, many health policy-makers, insurers and payers now demand that researchers also provide estimates of the cost of these interventions. There is very little in the literature on such estimates in the US, even though primary care providers have been advocating for payment for such services.
In this study, part of the Prescription for Health (P4H) program funded by the Robert Wood Johnson Foundation, we collected cost data from thirty primary care physician practices nationwide using a standardized study protocol, instructional guide, and data collection instruments. We estimated from the data, the start-up and incremental costs of providing behavioral change services for the leading health risk behaviors in such practices. The services targeted: Lack of physical activity, Unhealthy diet; Tobacco use; and Risky use of alcohol.Because the interventions were different, we used slightly different methods to collect and calculate the economic costs of each of the interventions. We report on our evaluation of these methods, and conclude that each of these estimation methods has merit. We also collected qualitative data on how each intervention was actually implemented.
We report on the results of our estimates of the incremental costs of implementing these basic behavioral change interventions in primary care physician practices. The direct costs ranged from $6.00 to $55 per patient per month, and overhead costs ranged from -$4.75 to 301 per patient per month in current dollars. Our report includes accounts on: (1) the actual field implementation of each intervention; and (2) explanations of the variations in the dollar numbers calculated.
While practice-based primary care research networks have proven adept laboratories for generating and answering relevant research questions, most practice-based studies lack estimates of the costs (economic data) necessary to develop, implement and sustain the practice-level interventions. Such estimates are not only useful for practice decisions and in making cohesive arguments to payers and policy makers about primary care compensation, but make the case for the need for redesigned health payment systems in the US.