Meenan Richard T, Baldwin Laura-Mae, Coronado Gloria D, Schwartz Malaika, Coury Jennifer, Petrik Amanda F, West Imara I, Green Beverly B
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
Popul Health Manag. 2021 Apr;24(2):255-265. doi: 10.1089/pop.2020.0041. Epub 2020 Jun 29.
BeneFIT is a 4-year observational study of a mailed fecal immunochemical test (FIT) program in 2 Medicaid/Medicare health plans in Oregon and Washington. In Health Plan Oregon's (HPO) collaborative model, HPO mails FITs that enrollees return to their clinics for processing. In Health Plan Washington's (HPW) centralized model, FITs are mailed directly to enrollees who return them to a centralized laboratory. This paper examines model-specific Year 1 development and implementation costs and estimates costs per screened enrollee. Staff completed activity-based costing spreadsheets. Non-labor costs were from study and external data. Data matched each plan's 2016 development and implementation dates. HPO development costs were $23.0K, primarily administration (eg, clinic recruitment). HPW development costs were $37.3K, 38.8% for FIT selection and mailing/tracking protocols. Year 1 implementation costs were $51.6K for HPO and $139.7K for HPW, reflecting HPW's greater outreach. Labor was 50.4% ($26.0K) of HPO's implementation costs, primarily enrollee eligibility and processing returned FITs, and was shared by HPO ($17.0K) and 6 participating clinics ($9.0K). Labor was 10.5% of HPW's implementation costs, primarily administration and enrollee eligibility. HPO's implementation costs per enrollee were 12.3% higher ($18.36) than for HPW ($16.34). Similar proportions of completed FITs among screening-eligibles produced a 15% lower cost per completed FIT in HPW ($89.75) vs. HPO ($105.79). Implementation costs for HPO only (without clinic costs) were $15.16/mailed introductory letter, $16.09/mailed FIT, and $87.35/completed FIT, comparable to HPW. Results highlight cost implications of different approaches to implementing a mailed FIT program in 2 Medicaid/Medicare health plans.
BeneFIT是一项为期4年的观察性研究，针对俄勒冈州和华盛顿州的2个医疗补助/医疗保险健康计划中的邮寄粪便免疫化学检测（FIT）项目。在俄勒冈州健康计划（HPO）的协作模式中，HPO邮寄FIT检测试剂盒，参保人将其返还至诊所进行处理。在华盛顿州健康计划（HPW）的集中模式中，FIT检测试剂盒直接邮寄给参保人，参保人再将其返还至一个集中实验室。本文研究了特定模式下第1年的开发和实施成本，并估算了每个接受筛查的参保人的成本。工作人员完成了基于活动的成本核算电子表格。非劳动力成本来自研究和外部数据。数据与每个计划2016年的开发和实施日期相匹配。HPO的开发成本为2.3万美元，主要用于行政管理（如诊所招募）。HPW的开发成本为3.73万美元，其中38.8%用于FIT检测试剂盒的选择以及邮寄/追踪方案。HPO第1年的实施成本为5.16万美元，HPW为13.97万美元，这反映出HPW的宣传力度更大。劳动力成本占HPO实施成本的50.4%（2.6万美元），主要用于参保人资格审核和处理返还的FIT检测试剂盒，由HPO（1.7万美元）和6家参与的诊所（9000美元）分摊。劳动力成本占HPW实施成本的10.5%，主要用于行政管理和参保人资格审核。HPO每个参保人的实施成本比HPW高12.3%（18.36美元对16.34美元）。在符合筛查条件的人群中，完成FIT检测的比例相似，但HPW每个完成检测的成本（89.75美元）比HPO（105.79美元）低15%。仅HPO的实施成本（不包括诊所成本）为每封邮寄的介绍信15.16美元、每盒邮寄的FIT检测试剂盒16.09美元以及每个完成检测的样本87.35美元，与HPW相当。研究结果突出了在2个医疗补助/医疗保险健康计划中实施邮寄FIT项目的不同方法所产生的成本影响。
