O1032: Development and application of a cost tool for the implementation of a primary care based intensive health behavior and lifestyle treatment

Background: Approximately 14.1 million children and adolescents in the United States have obesity. Despite the evidence base for intensive health behavior and lifestyle treatment (IHBLT) programs, access remains a challenge. There is also a growing need to support broad implementation and dissemination of financially sustainable, cost-effective programs, given the complexity of obesity and IHBLTs. The Healthy Weight Clinic (HWC) is a multidisciplinary evidence-based program in primary care that has been shown to improve BMI among children with overweight/obesity. This analysis aims to describe the development and application of a cost tool to help predict return on investment and sustainability of IHBLTs through current insurance reimbursement.

Methods: The spreadsheet-based cost tool includes parametric models of cost inputs (i.e., staff salary) and allows for scenario analyses (i.e., varying reimbursement rates based on staff and Medicaid rates). Case studies to apply the cost tool were conducted with 3 HWC sites (2 federally qualified health centers (FQHC) in Mississippi (MS) and Massachusetts (MA) and 1 academic medical center (MA) to assess the breakeven point for clinic patient volume (i.e., financial neutral point: operational costs=revenue) during implementation.

Results: Financial neutral points were based on average reimbursement rates per health center. For site 1 (MS FQHC) the cost of the program per patient was $1,305, the average revenue was $806 per patient through medical reimbursement, and the clinic needed to care for an average of 81 patients annually to break even. For site 2 (MA FQHC) the cost of the program per patient was $1,239, the average revenue was $1,663 per patient through medical reimbursement, and the clinic needed to care for an average of 37 patients annually to break even. For site 3 (MA academic medical center) the cost of the program per patient was $1,580, average revenue was $1,437 per patient through medical reimbursement, and the clinic needed to care for 55 patients annually to break even.

Conclusion: Utilizing a cost tool that captures reimbursement of clinical provider time and a minimum stream of clinical volume can equip decision makers in planning financially to implement and sustain a clinically based IHBLT.