ESTIMATING the COST of PREVENTIVE SERVICES
in Mental Health and Substance Abuse Under Managed Care

Model Four: Health Promotion Through Self-Care Education

This cost model was designed on the basis of an amalgamation of six publications-Kemper (1982); Vickery, Kalmer, Lowry, Constantine, Wright, and Loren (1983); Fries, Fries, Parcell, and Harrington (1992); Kemper, Lorig, and Mettler (1993); Leigh, Richardson, Beck, Kerr, Harrington, Parcell, and Fries (1992); and Vickery, Golaszewski, Wright, and Kalmer (1988)-and reviewed by Dorfman (2000), in references respectively numbered 29, 32, 40, 43, 51, and 52. Each study described a variety of interventions provided to adults (ages 19 to 65) or older adults (age 66 and older). Five of the six studies were conducted in a managed care setting, and one was offered at the worksite.

Across the six studies, a wide range of activities was provided to participants in order to promote positive health behaviors and self-care:

Workshops to train nurses to provide psychoeducational support to patients, including written materials, pamphlets, and booklets
Self-care guidelines, newsletters, books, and booklets for participants
Videotapes covering self-care
Access to a telephone information service staffed by a nurse
Individual health conferences with a nurse
Computer-based, serial, personalized health risk reports
Individualized recommendation letters and reports
One-on-one educational sessions with a physician
Access to a self-care drop-in center (Dorfman, 2000, p. 21)

The model was designed to incorporate all nine of these activities and to estimate the PMPM costs of all nine combined. Therefore, the PMPM costs are overstated for an MCO that uses only a subset of the activities.

Results
PMPM Cost

The median PMPM cost for the Least Expensive Scenario was $1.06. The median PMPM cost for the Most Expensive Scenario was $2.02, with a midpoint of $1.54.

Design and Input Values Used in the Model

Membership and Participation
The model begins with an estimation of the number of adults and older adults who are members of an MCO with 100,000 members. On the basis of 1990 census figures, these percentages were valued at 59 percent for adults and 11 percent for older adults. The model then uses an estimate of the percentage of each age group that is likely to agree to participate in a health promotion campaign (i.e., a series of health promotion and self-care activities throughout the year). These estimates for adults ranged from 45 percent to 90 percent in increments of 15 percent for each scenario (Least Expensive to Most Expensive). For older adults, the percentage started at 60 percent (Least Expensive Scenario) and went as high as 90 percent (Most Expensive Scenario) in increments of 10 percent.

Because some activities are costed out by household (e.g., a videotape mailed to a home), it is necessary to estimate the number of covered members per household for adults and older adult members. Based on data reported by Vickery et al. (1983), the ratio of older adult participants to households was set from 1.26 (Least Expensive) to 1.20 (Most Expensive) in increments of 0.02. For adults, this ratio ranged from 3.0 (Least Expensive) to 2.4 (Most Expensive) in increments of 0.20.

Other Expenses: Materials and Staff Time

The rest of the model consisted of 10 separate modules reflecting the various types of specific intervention activities that were described in the various studies reviewed by Dorfman (2000). Each module allowed for the cost estimation of written material, as well as clerical and professional labor spent in conducting one-on-one activities or group activities. In each module, the model used a separate estimate for the level of participation by adults or older adults. For example, although 9,000 adults may agree to participate in the series of activities, only 25 percent may actually show up to participate in a particular activity, such as an educational workshop.

Slightly different staff salaries, fringe-benefit rates (29 percent), and rates of productivity were assumed in Model 4 than in Models 1 through 3:

Clerical at $20,000 in $500 increments and 80 percent productivity
Nurses at $50,000 in $1,000 increments and 70 percent productivity
Psychologists at $50,000 in $1,000 increments and 70 percent productivity
Physicians at $100,000 in $2,000 increments and 70 percent productivity

Discussion

This intervention could be integrated easily into most staff- or independent-practice association (IPA)-model HMOs. Unlike some of the other interventions, there is not a heavy reliance on professional medical staff time, with the exception of the visit with a physician to review the health risk appraisal, which would seem to be reasonable medical practice in any case. It is important to note that the model's estimated total PMPM costs are the highest of all six models. That is because this type of intervention can employ so many different specific activities, all of which were included in the cost model. Any MCO considering the implementation of this preventive intervention should read the original research and decide which of all the possible activities it wishes to implement. The PMPM cost for each activity is presented in the Technical Appendix.

Table of Contents | Previous | Next