1. A Penny Saved… A Child Served The Cost-Saving Benefits of School-Based Health Centers June 13, 2011

2. Comprehensive School Based Health Clinics Veda Johnson, MD Assistant Professor of Pediatrics Emory University School of Medicine June 13, 2011

3. School based health clinics meeting the needs of the underserved… Increased access to quality healthcare Improved health outcomes Improved school attendance and academic performance Decreased healthcare costs

4. School based clinics… Decreased health care costs Reduced Emergency Room Use Reduced Hospitalization Reduced Drug Prescription Use Increased Preventative Visits (Decreased parental productivity losses)

5. Decreased health care costs… Decreased emergency room use: Adams EK, Johnson V. An elementary school-based health clinic: can it reduce Medicaid costs? Pediatrics. 2000;105(4 pt 1):780–788. Young TL, D’angelo SL, Davis J. Impact of a school based health center on emergency department use by elementary school student. J Sch Health. 2001;71(5):196–198. Guo JJ, Jang R, Cluxton RJ. Evaluation of health outcomes and costs among Medicaid recipients enrolled in school-based health centers. A prescription for success. Cincinnati, OH: Health Foundation for Greater Cincinnati;2004. Available at http://www.healthfoundation.org/publications.html. http://www.healthfoundation.org/publications.html

6. Decreased health care costs… Decreased emergency room use (cont’d) Key JD, Washington EC, Hulsey TC. Reduced emergency department utilization associated with SBHC enrollment. J Adolesc Health. 2002; 30:273-2. Santelli J, Kouzis A, Newcomer S. SBHCs and adolescent use of primary care and hospital care. J Adolesc Health. 1996; 19(4): 267-275. Webber MP, Carpiniello KE, Oruwariye T, Yungtai L, Burton WB, Appel DK. Burden of asthma in elementary school children: Do SBHCs make a difference? Arch Pediatr Adolesc Med. 2003; 157: 125-129.

7. Decreased health care costs… Decreased hospitalizations: Adams EK, Johnson V. An elementary school-based health clinic: can it reduce Medicaid costs? Pediatrics. 2000;105(4 pt 1):780–788. Guo JJ, Jan R, Keller KN, McCracken AL, Pan W, Cluxton RJ. Impact of SBHCs on Children with Asthma. J Adolesc Health. 2005: 37(4): 266-274. Analysis by the Empire Health Group for the NY Coalition of School Based Primary Care, 2005. Santelli J, Kouzis A, Newcomer S. SBHCs and adolescent use of primary care and hospital care. J Adolesc Health. 1996; 19(4): 267-275.

8. Decreased health care costs… Decreased drug prescription use: Adams EK, Johnson V. An elementary school-based health clinic: can it reduce Medicaid costs? Pediatrics. 2000;105(4 pt 1):780–788. Guo JJ, Jang R, Cluxton RJ. Evaluation of health outcomes and costs among Medicaid recipients enrolled in school-based health centers. A prescription for success. Cincinnati, OH: Health Foundation for Greater Cincinnati;2004. Available at http://www.healthfoundation.org/publications.html http://www.healthfoundation.org/publications.html Guo JJ, Wade TJ, Pan W, Keller KN. School-based health centers: Cost-benefit analysis and Impact on health care disparities. AJPH. 2010; 100 (9): 1617-1623.

9. Decreased health care costs… Increased preventative services: Adams EK, Johnson V. An elementary school-based health clinic: can it reduce Medicaid costs? Pediatrics. 2000;105(4 pt 1):780–788. Santelli J, Kouzis A, Newcomer S. SBHCs and adolescent use of primary care and hospital care. J Adolesc Health. 1996; 19(4): 267-275.

10. Decreased health care costs… Reduced Parental Productivity Losses: Guo JJ, Wade TJ, Pan W, Keller KN. School-based health centers: Cost-benefit analysis and Impact on health care disparities. AJPH. 2010; 100 (9): 1617-1623. Over a 3 year period, SBHCs in Cincinnati prevented parental productivity losses by an estimated $540,000 to $1,085,000.

11. Decreased health care costs – Whitefoord Elementary School - Based Health Clinic Adams EK, Johnson V. An elementary school-based health clinic: can it reduce Medicaid costs? Pediatrics. 2000;105(4 pt 1):780–788 Compared Medicaid costs to children enrolled in a SBHC to those not enrolled in a SBHC Summary of findings: Decrease in total Medicaid costs per child over 2 year period w/SBHC Significant decrease in In-Patient costs Significant decrease in prescription drug use costs Significant decrease in emergency room costs Decrease more significant across all categories if child used SBHC as medical home For children with asthma, decrease in Medicaid cost for total yearly expenditures with significant decreases in inpatient and drug costs.

12. Decreased health care costs – Whitefoord Elementary School - Based Health Clinic Average 1994 Costs for Whitefoord Children Versus Comparison Children Whitefoord (n = 269) Other(n = 594) t Test Total yearly expense (per individual) $1741.97 $1772.38 -.155 Category of service breakdowns Inpatient $ 126.15 $ 212.48 -.821 Outpatient $ 188.84 $ 228.79 -.576 Nonemergency transport $ 504.22 $ 480.44.358 Physician $ 384.07 $ 349.16.678 EPSDT $ 93.67 $ 91.44.264 Drug $ 244.69 $ 302.77 -.746 Emergency department $ 103.40 $ 101.34.139 Average 1995 Costs (Ever Used) Whitefoord(n =262) Other(n = 632)t Test Total yearly expense (per individual)$1206.46 $1493.74 -1.090 Category of service breakdowns Inpatient $ 132.82 $ 272.25 -1.389 Outpatient $ 155.05 $ 358.45 -1.153 Physician $ 260.75 $ 250.56.234 EPSDT $ 101.67 $ 80.97 -.718* Drug $ 242.73 $ 200.96 1.119 Emergency department $ 84.67 $ 112.24 -1.732‡

13. Decreased health care costs – Whitefoord Elementary School - Based Health Clinic Average 1996 Costs (Ever Used) Whitefoord(n = 274)Other(n = 349)t Test Total yearly expense (per individual) $898.98 $2360.46 -4.133* Inpatient $197.24 $ 748.97 -2.129† Outpatient $129.57 $ 175.74 -1.118 Nonemergency transport $ 56.82 $ 122.28 -2.077† Physician $137.75 $ 287.49 -3.177* EPSDT $ 59.81 $ 119.77 -5.609* Drug $217.79 $ 393.31 -3.440* Emergency department $ 52.97 $ 143.64 -3.608* Average 1996 Costs (Whitefoord as usual provider) Whitefoord(n =169)Other(n = 349)t Test Total yearly expense (per individual) $727.30 $2360.46 -4.619* Inpatient $110.39 $ 748.97 -2.454† Outpatient $104.13 $ 175.74 -1.449 Nonemergency transport $ 45.18 $ 122.28 -2.295† Physician $118.59 $ 287.49 -3.589* EPSDT $ 61.54 $ 119.77 -5.004* Drug $203.44 $ 393.31 -3.594* Emergency department $ 36.19 $ 143.64 -4.414* * t value significant at.01 level. † t value significant at.05 level. ‡ t value significant at.10 level.

14. Decreased health care costs… Healthcare costs for asthma 2006 - $6 billion to treat asthma in children nationally ‘Asthma is one of the costliest pediatric health conditions, accounting for nearly 14% of all pediatric hospitalizations in 2008. Asthma is associated with a 50% increase in the risk that a pediatric emergency department visit will result in an inpatient admission. Medicaid directors report that expenditures for asthma-related hospitalization and emergency department care rank among their highest pediatric health care costs.’ The Affordable Care Act, Medical Homes, and Childhood Asthma: A Key Opportunity for Progress. www.rchnfoundation.org/images/FE/.../site176/.../MedicalHomesBrief.pdfwww.rchnfoundation.org/images/FE/.../site176/.../MedicalHomesBrief.pdf Five of the previously cited studies demonstrate significantly reduced asthma related health care costs.

15. Decreased health care costs – Whitefoord Elementary School - Based Health Clinic Average 1994 ASTHMA Costs for Whitefoord Asthmatic Children (Ever Used in 1995) Versus Comparison Children Whitefoord(n 5=26)Other(n = 68)t Test Total yearly expense (per individual) $2372.77 $2414.42 -.052 Inpatient $ 422.36 $ 727.35 -.469 Drug $ 501.57 $ 591.94 -.531 Emergency department $ 221.60 $ 226.71 -.059 Average 1995 ASTHMA Costs Whitefoord(n = 34)Other(n = 81)t Test Total yearly expense (per individual)$1757.80 $2540.93 -1.030 Inpatient $ 351.94 $1259.35 -1.966† Drug $ 447.32 $ 363.02.652 Emergency department $ 197.16 $ 279.72 -.726 Average 1996 ASTHMA Costs for 1995 Patients Whitefoord(n = 34)Other(n = 53)t Test Total yearly expense (per individual)$1966.77 $4078.38 -2.176 Inpatient $ 706.88 $2311.52 -1.899‡ Drug $ 260.44 $ 441.12 -2.139† Emergency department $ 212.32 $ 388.44 -1.106

16. School based health clinics meeting the needs of the underserved… Increased access to quality healthcare Improved health outcomes Improved school attendance and academic performance Decreased healthcare costs