Behrends Czarina N, Eggman Ashley A, Gutkind Sarah, Bresnahan Marie P, Fluegge Kyle, Laraque Fabienne, Litwin Alain H, Meissner Paul, Shukla Shuchin J, Perumalswami Ponni V, Weiss Jeffrey, Wyatt Brooke E, Schackman Bruce R
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (Drs Behrends and Schackman and Mss Eggman and Gutkind); New York City Department of Health & Mental Hygiene, Queens, New York (Ms Bresnahan and Drs Fluegge and Laraque); Albert Einstein College of Medicine, Bronx, New York (Drs Litwin and Shukla and Mr Meissner); Montefiore Medical Center, Bronx, New York (Drs Litwin and Shukla); Icahn School of Medicine at Mount Sinai, New York, New York (Drs Perumalswami and Weiss); and Mount Sinai Hospital, New York, New York (Dr Perumalswami and Ms Wyatt).
J Public Health Manag Pract. 2019 May/Jun;25(3):253-261. doi: 10.1097/PHH.0000000000000806.
To estimate the cost of delivering a hepatitis C virus care coordination program at 2 New York City health care provider organizations and describe a potential payment model for these currently nonreimbursed services.
An economic evaluation of a hepatitis C care coordination program was conducted using micro-costing methods compared with macro-costing methods. A potential payment model was calculated for 3 phases: enrollment to treatment initiation, treatment initiation to treatment completion, and a bonus payment for laboratory evidence of successful treatment outcome (sustained viral response).
Two New York City health care provider organizations.
Care coordinators and peer educators delivering care coordination services were interviewed about time spent on service provision. De-identified individual-level data on study participant utilization of services were also used.
Project INSPIRE is an innovative hepatitis C care coordination program developed by the New York City Department of Health and Mental Hygiene.
Average cost per participant per episode of care for 2 provider organizations and a proposed payment model.
The average cost per participant at 1 provider organization was $787 ($522 nonoverhead cost, $264 overhead) per episode of care (5.6 months) and $656 ($429 nonoverhead cost, $227 overhead, 5.7 months) at the other one. The first organization had a lower macro-costing estimate ($561 vs $787) whereas the other one had a higher macro-costing estimate ($775 vs $656). In the 3-phased payment model, phase 1 reimbursement would vary between the provider organizations from approximately $280 to $400, but reimbursement for both organizations would be approximately $220 for phase 2 and approximately $185 for phase 3.
The cost of this 5.6-month care coordination intervention was less than $800 including overhead or less than $95 per month. A 3-phase payment model is proposed and requires further evaluation for implementation feasibility. Project INSPIRE's HCV care coordination program provides good value for a cost of less than $95 per participant per month. The payment model provides an incentive for successful cure of hepatitis C with a bonus payment; using the bonus payment to support HCV tele-mentoring expands HCV treatment capacity and empowers more primary care providers to treat their own patients with HCV.
评估在纽约市的2家医疗服务机构实施丙型肝炎病毒护理协调项目的成本，并描述针对这些目前未获报销服务的潜在支付模式。
采用微观成本核算方法与宏观成本核算方法对丙型肝炎护理协调项目进行经济评估。计算了3个阶段的潜在支付模式：登记至开始治疗、开始治疗至治疗结束，以及针对治疗成功结果（持续病毒学应答）的实验室证据的奖金支付。
纽约市的2家医疗服务机构。
就提供护理协调服务所花费的时间，对提供护理协调服务的护理协调员和同伴教育者进行了访谈。还使用了关于研究参与者服务利用情况的匿名个人层面数据。
“激励计划”（INSPIRE）项目是纽约市卫生和精神卫生部门开发的一项创新性丙型肝炎护理协调项目。
2家医疗服务机构每位参与者每次护理的平均成本以及一种提议的支付模式。
1家医疗服务机构每位参与者每次护理（5.6个月）的平均成本为787美元（非间接费用成本522美元，间接费用264美元），另一家为656美元（非间接费用成本429美元，间接费用227美元，5.7个月）。第一家机构的宏观成本核算估计较低（561美元对787美元），而另一家的宏观成本核算估计较高（775美元对656美元）。在三阶段支付模式中，第一阶段的报销在各医疗服务机构之间从约280美元到400美元不等，但两家机构在第二阶段的报销约为220美元，第三阶段约为185美元。
这项为期5.6个月的护理协调干预措施的成本，包括间接费用在内不到800美元，即每月不到95美元。提出了一种三阶段支付模式，需要对其实施可行性进行进一步评估。“激励计划”项目的丙型肝炎护理协调项目以每位参与者每月不到95美元的成本提供了良好价值。该支付模式通过奖金支付为丙型肝炎的成功治愈提供了激励；利用奖金支付来支持丙型肝炎远程指导扩大了丙型肝炎治疗能力，并使更多初级保健提供者能够治疗自己的丙型肝炎患者。
