1. Calculating the Cost of Care Coordination A quick and dirty guide to estimation Deborah Allen, ScD Catalyst Center Boston University School of Public Health

2. Assumptions Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally Any child or youth with special health care needs may need access to care coordination at some time An organized, statewide system of care coordination is the only way to assure universal access Care coordinators can effectively serve children and adolescents with a range of disabilities or chronic conditions – At least at a baseline level

3. Relevant variables The number of children with special health care needs in the state The caseload per FTE care coordinator per year The salary per FTE care coordinator per year

4. The number of children with special health care needs in WA 2000 Census: 1,513,843 under age 18 Of whom 13.7% reported to have special health care needs on the National CSHCN Survey That means 207,396 children with special health care needs For purposes of estimation: 200,000 children with special health care needs

5. The caseload per FTE care coordinator Depends on model and case mix Washington has 500 pediatricians -> average pediatric panel of 3,000 children If assume 1 FTE care coordination per average pediatric panel of about 3,000 – Each care coordinator is available to about 400 children with special health care needs, of whom 80 will probably require ongoing support – System requires 500 care coordinators If assume 1 FTE care coordinator can only serve 200 children of whom 40 will require ongoing support – System requires 1,000 care coordinators

6. Implications of a compromise figure If, 1 care coordinator can serve a total caseload of 300 children with special health care needs Of whom 60 will require ongoing support – Development of a care plan – Bi-weekly check-in with family – One annual visit to school or home Estimate 120 days/year spent on these 60 children – 140 days/year spent on remaining 240 children -> 750 care coordinators needed to serve child population of WA

7. Washington labor market salaries For nurse manager $37.75* For staff nurse $30.54 For health educator $24.22 For medical/public health social worker $23.45 For child and family social worker $17.62 For medical assistant $14.67

8. Annual salary At hourly rate of $35$72,800 At hourly rate of $25$52,000 At hourly rate of $15$31,200

9. System costs for 750 care coordinators with benefits Advanced practice RN $68,250,000 Social worker$48,750,000 Certified paraprofessional$29,250,000 Plus estimated $1,000,000 system oversight costs Cost is between $30 and $70 million!

10. BUT Cost per child – Range is $19 to $46/year Cost per child with special health care needs – Range is to $150 to $350/year System savings if each care coordinator averts two major hospitalizations per year $37,500,000