1. Joy Hsu, M.S, M.D., Medical Officer National Center for Environmental Health Division of Environmental Hazards and Health Effects Centers for Disease Control and Prevention Where Financial Sustainability Exists

2. Amanda Reddy, M.S., Director of Programs and Impact National Center for Healthy Housing Where Financial Sustainability Exists

3. AMANDA REDDY Director of Strategy and Impact Where Financial Sustainability Exists

4. Ongoing funding is critical to ensuring the long-term success and maximum impact of your program and services. But it may require you to think differently about the services you provide.

6. Limited resources Need to bring services to scale Emerging opportunities from healthcare reform Potential funders weighing competing programs A business case can help you articulate the unique value of your program effectively and efficiently. THE BUSINESS CASE: Why it’s important for your program

7. Pro Tip Listen to what’s important to potential funders, payers and partners. That will help you build they business case they want and need to hear.

8. Are home-based asthma services a good value? Yes, but it depends…

9. THE EVIDENCE BASE: Are home-based asthma services a good value? Community Guide to Preventive Services Minor to moderate intensity interventions provide good value for the money invested: $231-$1,720 per participant $5.30-$14.00:$1.00 invested $12-$57/Symptom-Free Day www.thecommunityguide.org/asthma/supportingmaterials/Asthma%20Econ.pdf

10. THE EVIDENCE BASE: Are home-based asthma services a good value? ARC Business Case EPA Award Winners More recent papers Provide data from real- world settings, information about other settings and populations. Forthcoming paper from NCHH reports a range of 2.03:1-3.58:1 ROI

11. Are home-based asthma services a good value? Yes, but it depends…

12. PERSPECTIVE: Factors that drive cost and revenue Perspective determines which potential costs and benefits are included in an economic evaluation Two common perspectives include: Societal Payer

13. PERSPECTIVE: Factors that drive cost and revenue Perspective determines which potential costs and benefits are included in an economic evaluation Two common perspectives include: Societal Payer

14. THE PAYER PERSPECTIVE: Factors that drive cost and revenue The payer perspective examines costs and benefits from the viewpoint of the person or entity ultimately responsible for the financial cost of the program or service; for example, an insurance company or a foundation. Does not (typically) monetize outcomes that don’t result in savings (or other benefit) to the payer

15. THE EVIDENCE BASE: Are home-based asthma services a good value? Community Guide to Preventive Services Minor to moderate intensity interventions provide good value for the money invested: $231-$1,720 per participant $5.30-$14.00:$1.00 invested $12-$57/Symptom-Free Day www.thecommunityguide.org/asthma/supportingmaterials/Asthma%20Econ.pdf Includes averted costs from improvements in productivity

16. PROGRAM DESIGN: Factors that drive cost and revenue Targeting Scope Intensity Staffing Number of visits

17. MEASUREMENT TIMEFRAME: Factors that drive cost and revenue How long will it take to achieve specified environmental and health outcomes? How long will it take to realize savings, if any? How long can the benefits be expected to last? Trade-off between wanting to capture short-term improvements but not having such a short evaluation timeframe that the longer-term benefits are underestimated and other cyclical variations are not accounted for.

18. RULES FOR ADMINISTRATION: Factors that drive cost and revenue How many people will benefit from the services offered? Will you impose a limit on the number of times a client is eligible for a service? Will there be a minimum time-interval limit between multiple interventions? Will you offer services for an eligible client’s second residence? Will you provide services to additional client(s) in a home with a limited scope or reduced payment?

19. Cost description or cost analysis Most basic type of economic evaluation. Describes program costs. Cost-effectiveness Cost per unit of improvement (often the incremental cost of one program over another). Benefit-cost/cost-benefit/ROI Weighs costs of program to dollar value of benefits over a defined period. Cost-utility Compares costs to outcomes measured in health years. Think about the question you’re trying to answer and whom you’re trying to convince.

20. Cost description or cost analysis Most basic type of economic evaluation. Describes program costs. Cost-effectiveness Cost per unit of improvement (often the incremental cost of one program over another). Benefit-cost/cost-benefit/ROI Weighs costs of program to dollar value of benefits over a defined period. Cost-utility Compares costs to outcomes measured in health years. Identifies and places dollar values on the costs of services and weighs those costs against the dollar value of benefits accrued over a defined period. RETURN ON INVESTMENT (ROI) is a type of benefit- cost analysis. Example: Return of $5.30 for every $1.00 invested in the program

21. Pro Tips Use a comparison group whenever possible or try to estimate what would have been likely without intervention. Some costs may go up, but the net benefit may still be savings. In projecting costs, remember that there may be costs associated with providing services to a payer, e.g., administrative time to process claims. Interventions don’t have to save money to be compelling. There is a role for cost-neutral or cost-effective interventions and this may be compelling to many potential funders.

22. Pro Tips You can use data from other sources. State health departments have useful information about hospital admissions or ED visits, and many programs publish data about cost and health outcomes. Find one that’s similar to yours and use it to help you project your own costs and savings. You may be able to leverage other funding so that costs are not borne by a single payer or funder. This is also known as blended or braided funding. Sustainability requires a sustained effort to demonstrate the value of your services.

23. Aetna’s Delaware Physician’s Care, Inc 2011-2014 www.nchh.org/Program/DemystifyingHealthcareFinancing/CaseStudies.asp x

24. PUTTING IT TOGETHER

25. TOOLS YOU CAN USE: Get started on your business case today NCHH Healthcare Financing Resource Library CDC Community Guide to Preventive Services and other forthcoming publications CDC Community Guide to Preventive Services Nemours Preparing for a Conversation with Medicaid worksheet CDC Program Evaluation Guides CDC Approaches to Reimbursement Report ARC Business Case EPA Award Winners Hall of Fame EPA’s Value Proposition Toolkit AHRQ’s Asthma ROI Calculator, CDC Chronic Disease Calculator AHRQ’s Asthma ROI CalculatorCDC Chronic Disease Calculator

26. Expert reports + real-world examples + these tools + your own program’s information/experience = A compelling (and fundable) story

27. www.nchh.org/Program/EquippingStatesforReimbursement.aspx FREE TRAINING AND TECHNICAL ASSISTANCE AVAILABLE!

28. AMANDA REDDY areddy@nchh.org