We review preliminary estimates from pilot testing a cost estimation methodology developed to identify the resources required to implement a set of Foundational Public Health Services as recommended by the Institute of Medicine and defined by the Public Health Leadership Forum

Mamaril, C. B.

Mays, Glen P.

English

University of Kentucky

University of KentuckyUKnowledgeHealth Management and Policy Presentations Health Management and Policy11-18-2014Cost Estimates of Foundational Public HealthServices: Results from Piloting an ExpertConsensus MethodologyC. B. MamarilUniversity of Kentucky, cbmamaril@uky.eduGlen P. MaysUniversity of Kentucky, glen.mays@cuanschutz.eduRight click to open a feedback form in a new tab to let us know how this document benefits you.Follow this and additional works at: https://uknowledge.uky.edu/hsm_presentPart of the Health and Medical Administration Commons, Health Economics Commons, andthe Health Services Research CommonsThis Presentation is brought to you for free and open access by the Health Management and Policy at UKnowledge. It has been accepted for inclusionin Health Management and Policy Presentations by an authorized administrator of UKnowledge. For more information, please contactUKnowledge@lsv.uky.edu.Repository CitationMamaril, C. B. and Mays, Glen P., "Cost Estimates of Foundational Public Health Services: Results from Piloting an Expert ConsensusMethodology" (2014). Health Management and Policy Presentations. 85.https://uknowledge.uky.edu/hsm_present/85Cost Estimates of Foundational Public Health Services:  Results from Piloting an Expert Consensus Methodology   C.B. Mamaril, Ph.D. Glen P. Mays, Ph.D., MPH  APHA Annual Meeting      |       New Orleans, LA      |       18 November 2014 Robert Wood Johnson Foundation Washington PBRN Delivery and Cost Study (DACS) Research Team (Univ. of Washington)  Betty Bekemeier, Ph.D.  Justin Marlowe, Ph.D. Kentucky Health Departments Association (KHDA)  Georgia Heise, DrPH (2014 NACCHO President)  KHDA Finance Workgroup Graduate Research Assistance of: • Keith Branham, UK DrPH student • Carrie Holsinger, UK DrPH student • Scott Secamiglio, MPH Acknowledgements Workgroup on Public Health Cost Estimation Terry Allan, MPH Cuyahoga County (OH) Board of Health  Ricardo Basurto-Davila, PhD Los Angeles County (CA) Health Department  Patrick Bernet, PhD Florida Atlantic University  Yu-Wen Chiu, DrPH Louisiana State University  Phaedra Corso, PhD University of Georgia   Dwight V. Denison, PhD University of Kentucky  Laura Dunlap, PhD Research Triangle Institute  Thomas Getzen, PhD Temple University International Health Economics Association  Cezar Mamaril, PhD University of Kentucky  Justin Marlowe, PhD University of Washington  Glen Mays, PhD University of Kentucky  Jennifer Tebaldi, MBA State of Washington Department of Health  Herminia Palacio, MD Robert Wood Johnson Foundation  Jeanne S. Ringel, PhD RAND  Rexford Santerre, PhD University of Connecticut   Sergey Sotnikov, PhD U.S. Centers for Disease Control and Prevention  Study Manager:  Lizeth Fowler, MS, MPA University of Kentucky Cost estimation methods Prospective “expected cost” methods - Vignettes - Surveys with staff and/or administrators - Delphi group processes Concurrent “actual cost” methods (micro-costing) - Time studies with staff - Activity logs with staff - Direct observation Retrospective “cost accounting” methods - Modeling and decomposition using administrative records - Surveys with staff and/or administrators  Key issues: What’s the cost of capability? Delineating state vs. local roles and division of effort Identifying scale and scope effects - By population served - By range of programs supported (portfolio effect) Identifying input factors that affect costs - Resource prices - Case mix Identifying key output differences across settings - Intensity - Quality - Reach   Estimating the Costs of Foundational Public Health  Capabilities: A Recommended Methodology  Available at http://works.bepress.com/glen_mays/128/ Background and Overview:  Piloting the Methodology in Kentucky Discussions with Kentucky Health Department Association (KHDA) to introduce & explain Foundational Public Health Services (FPHS) framework using RESOLVE FPHS articulation/definitions document Buy-in: KHDA formed a finance workgroup to evaluate how to incorporate FPHS framework into current financial & performance reporting system. • Crosswalk of chart of accounts with FPHS framework Participation in Cost-Estimation Pilot Project (6 members of workgroup serving as a representative sample – from small rural to large urban to multi-county health districts) Development of a cost data collection instrument Costing Methodology (1/2) Adapt Washington DACS instrument as a starting template and modify & enhance accordingly Goal is for cost data collection instrument to be efficiently self-administered and capture estimates that account for uncertainty (i.e. dynamic nature of public health - FPHS demand and supply) Empirical approach: Estimate FPHS Costs by modeling uncertainty associated with cost data collected • Given sample size, quantify uncertainty through model simulation Generate probability distribution – the range of all possible values and the likelihood of their occurence • Independent variables / Inputs → Input Distribution • Dependent variable / Output → Distribution of output values calculated from all possible combinations (‘scenarios’) of input values • Best of all, these probability distributions can be graphed!       Programs/Activities Specific to Local Community Need      Cost Centers - 715, 718, 730, 748, 769, 810, 813, 858, 860, 861, 862, 863, 864, 865,      866, 867, 868, 869, 882, 891Additional ServicesEnvironmental Public HealthChronic Disease & Injury PreventionCommunicable Disease ControlMaternal, Child & Family HealthAccess to & Linkage with Clinical Care760, 766, 767, 768, 803, 804, 808, 816, 833, 848, 852, 853, 854712, 741, 770, 800, 802, 811, 883Foundational Public Health Programs "Responsibilities" 722, 723, 738, 765, 805, 809, 818, 832, 836, 841, 856, 857500, 520, 540, 560, 580, 591801, 806, 807, 842, 843, 845Organizational/Business Competencies (Governance, Equity, IT, HR, etc.) - 724, 750, 888, 894, 897, 898Foundational Public Health CapabilitiesAssessment (Surveillance and Epidemiology) - 844, 890Emergency Preparedness & Response (All Hazards)-746,747,749,757,759,763,771,815,821,822,823,824,825CommunicationsPolicy Development & Support - 836, 890Community Partnership Development - 735, 736, 740, 756, 761, 837, 893Across all Programs (i.e. cross-cutting)Crosswalk of FPHS with Kentucky’s Chart of Accounts Survey Instrument (4/4): Current Attainment Scale  Used to derive FPHS Projected Costs “Based on your understanding of how each public health foundational capability and foundational area is defined, please provide your global or overall assessment on the following question: For each foundational category, what is the estimated percentage currently being met by your health department? “ Estimation of “projected” costs  from current attainment ratings Attainment level Cost A. Cost at current attainment level B. Projected cost of full attainment   A B 100% 0% Costing Methodology Outputs Methodology produces a cost distribution for each Foundational Capability (FC) and Foundational Area (FA) specified in the National FPHS Definition document Separate estimates of “current” and “projected” costs Current: cost of resources currently used to produce FCs and FAs Projected: cost of resources estimated to be required to fully meet FC and FA definitions, based on current levels of attainment       Costing Methodology Outputs Foundational Capabilities (FCs) Costs − Health Assessment  − Emergency Preparedness − Communications − Policy Development and Support − Community Partnership Development − Organizational Competencies  Foundational Areas (FA) Costs − Communicable Disease Control − Chronic Disease & Injury Prevention − Environmental Health − Maternal and Child Health − Access and Linkage to Clinical Care  Total costs = ∑FC + ∑FA      0 1 2 3 4 5 6 7 8 90505050505.0% 90.0% 5.0%0.64 4.59fc_assessment_ToT Mean = 2.3490 5% = 0.6352 95% = 4.58675.0% 90.0% 5.0%1.09 7.08fc_assessment_ToT_need Mean = 3.8989 5% = 1.0887 95% = 7.0801Foundational Capability (FC) – Assessment (per capita $) Projected Current 5.0% 90.0% 5.0%1.57 8.54fc_emergencyprep_ToT Mean = 4.5238 5% = 1.5693 95% = 8.54195.0% 90.0% 5.0%2.84 14.87fc_emergencyprep_ToT_need Mean = 8.342 5% = 2.837 95% = 14.8710 2 4 6 8 0 2 4 6 8 0050505FC_Emergency Preparedness-All Hazards Response (per capita $) Projected Cur ent 5.0% 90.0% 5.0%0.106 0.575fc_communication_ToT Mean = 0.34280 5% = 0.10604 95% = 0.575395.0% 90.0% 5.0%0.164 0.988fc_communication_ToT_need Mean = 0.5520 5% = 0.1643 95% = 0.98830 2 4 6 8 0 20505050FC_Communications (per capita $) Projected Current 5.0% 90.0% 5.0%0.922 4.430fc_policy_ToT Mean = 2.4427 5% = 0.9216 95% = 4.42985.0% 90.0% 5.0%1.32 6.92fc_policy_ToT_need Mean = 3.9134 5% = 1.3200 95% = 6.91970 1 2 3 4 5 6 7 8 90505050505FC_Policy Development & Support (per capita $) Project d Current 5.0% 90.0% 5.0%1.51 5.69fc_communitypart_ToT Mean = 3.4246 5% = 1.5055 95% = 5.68830 2 4 6 8 0 2050505055.0% 90.0% 5.0%1.64 9.06fc_communitypart_ToT_need Mean = 5.066 5% = 1.641 95% = 9.063FC_Community Partnership Development (per capita $) Projected Current 5.0% 90.0% 5.0%8.54 17.96fc_orgcompetent_ToT Mean = 13.258 5% = 8.539 95% = 17.9580 5 0 5 0 5 0 5 00246802465.0% 90.0% 5.0%10.19 33.11fc_orgcompetent_ToT_need Mean = 21.064 5% = 10.187 95% = 33.106FC_Organizational Competencies (per capita $) Projected Current 5.0% 90.0% 5.0%1.84 7.63af_communicable_ToT Mean = 4.4493 5% = 1.8447 95% = 7.63150 2 4 6 8 0 2 40505055.0% 90.0% 5.0%1.79 10.45af_communicable_ToT_need Mean = 5.845 5% = 1.785 95% = 10.447Foundational Area (FA)_Communicable Disease Control (per capita $) Projected Curr nt 5.0% 90.0% 5.0%2.29 8.26af_chronic_ToT Mean = 5.0486 5% = 2.2900 95% = 8.25760 2 4 6 8 0 2 4 6 80505055.0% 90.0% 5.0%2.76 14.03af_chronic_ToT_need Mean = 7.977 5% = 2.760 95% = 14.033FA_Chronic Disease & Injury Prevention (per capita $) Project  Current 5.0% 90.0% 5.0%3.87 11.33af_enivornmental_ToT Mean = 7.322 5% = 3.874 95% = 11.3300 2 4 6 8 0 2 4 602468024685.0% 90.0% 5.0%3.95 13.11af_environmental_ToT_need Mean = 8.316 5% = 3.948 95% = 13.108FA_Environmental Public Health (per capita $) Projected Current 5.0% 90.0% 5.0%7.82 25.11af_maternalchild_ToT Mean = 15.850 5% = 7.820 95% = 25.1080 0 0 0 0 0 001234567895.0% 90.0% 5.0%10.7 49.2af_maternalchild_Tot_need Mean = 28.559 5% = 10.674 95% = 49.245FA_Maternal Child and Family Health (per capita $) Projected Current 5.0% 90.0% 5.0%3.18 9.04af_accesslinkage_ToT Mean = 6.0262 5% = 3.1826 95% = 9.04170 2 4 6 8 0 2 4 60505055.0% 90.0% 5.0%3.56 13.56af_accesslinkage_ToT_need Mean = 8.291 5% = 3.564 95% = 13.561FA_Access to & linkage w/ Clinical Care (per capita $) Projected Current 5.0% 90.0% 5.0%19.57 33.38TFC_capability_ToT Mean = 26.341 5% = 19.569 95% = 33.3750 0 0 0 0 0 0 0012345678905.0% 90.0% 5.0%29.2 56.5TFC_capability_ToT_need Mean = 42.836 5% = 29.207 95% = 56.527Foundational Capability – Total Costs per capita (Current & Projected) Projecte  Current 5.0% 90.0% 5.0%28.68 49.93TFA_areas_ToT Mean = 38.695 5% = 28.676 95% = 49.9280 0 0 0 0 0 0 0 0 0 0012345675.0% 90.0% 5.0%38.0 81.7TFA_areas_ToT_need Mean = 58.988 5% = 37.995 95% = 81.738Foundational Areas_Total Costs per capita (Current & Projected) Projected Current 5.0% 90.0% 5.0%52.7 78.3FPHS_TOTAL Mean = 65.036 5% = 52.750 95% = 78.3230 0 0 0 0 0 0 001234565.0% 90.0% 5.0%76.7 127.5FPHS_TOTAL_need Mean = 101.82 5% = 76.75 95% = 127.46Total Local Per Capita Cost Estimates:  Current and Projected Projected Current 5.16182.47102.19242.15361.76361.71911.68331.54431.21771.20091.07850.727330.664620.590700.448620.419751 0 1 2 3 4 5 6FPHS_TOTALRegression - Mapped Values11.6566.92843.66233.37102.99122.72012.60142.23771.80341.67950.24657-20 2 4 6 810 12FPHS_TOTAL_needRegression - Mapped ValuesSensitivity Analysis for Total FPHS Costs per capita (current & projected) – standardized beta coefficients How Sensitive Are Total Costs to FCs and FAs Projected Current Next Steps: National Estimates National stratified, nested sample of state and local jurisdictions Selection of 6 states stratified by administrative structure:  • Centralized:  AR, SC • Shared:   FL, GA (KY) • Decentralized: NY, CA (WA) Selection of 3 local jurisdictions in each state, stratified by  population:   <50k   |   50-299k     |     >=300k  Supplement data already collected from KY, WA Web-based survey administration with telephone support For More Information 111 Washington Avenue, Suite 201 Lexington, KY 40536 859-218-0113  Supported by The Robert Wood Johnson Foundation Email:    publichealthPBRN@uky.edu Web:       www.publichealthsystems.org Journal:  www.FrontiersinPHSSR.org Archive:  works.bepress.com/glen_mays Blog:       publichealtheconomics.org   Nat iona l  Coordinat ing  Center  

Cost Estimates of Foundational Public Health Services: Results from Piloting an Expert Consensus Methodology

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Cost Estimates of Foundational Public Health Services: Results from Piloting an Expert Consensus Methodology

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