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Articles   |    
The Return on Investment of Postdischarge Follow-Up Calls for Suicidal Ideation or Deliberate Self-Harm
John S. Richardson, M.P.H.; Tami L. Mark, Ph.D., M.B.A.; Richard McKeon, Ph.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300196
View Author and Article Information

Mr. Richardson and Dr. Mark are with the Division of Behavioral Health and Quality Research, Truven Health Analytics, Bethesda, Maryland. Mr. Richardson is also currently a student with the Department of Health Management and Policy, University of Michigan, Ann Arbor. Dr. McKeon is with the Division of Suicide Prevention, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Send correspondence to Dr. Mark (e-mail: tami.mark@truvenhealth.com).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Transitions of care are critical for individuals at risk of suicide. This study determined the return on investment (ROI) for providing postdischarge follow-up calls to patients at risk of suicide who are discharged from a hospital or an emergency department.

Methods  Claims data were from the 2006–2011 Truven Health MarketScan Commercial Claims and Encounters Database and Multi-State Medicaid Database. Cost estimates were from eight call centers that provide postdischarge follow-up calls. The ROI was estimated for the 30 days after discharge and was calculated from a payer’s perspective (return gained for every $1 invested). One-way and probabilistic sensitivity analyses were used to examine the influence of variations of ROI model inputs.

Results  Under base case assumptions, the estimated ROI was $1.76 for commercial insurance and $2.43 for Medicaid for patients discharged from a hospital and $1.70 for commercial insurance and $2.05 for Medicaid for those discharged from an emergency department. Variation in the effect size of postdischarge contacts on reducing readmission had the largest effect on the ROI, producing a range from $0 to $4.11. The ROI would be greater than $1 for both payers and across both discharge settings as long as postdischarge contact could reduce readmission by at least 13.3%. Sensitivity analyses indicated a 77% probability (commercial) and an 88% probability (Medicaid) that the ROI would be greater than $1 among hospital discharges; the probabilities among emergency department discharges were 74% (commercial) and 82% (Medicaid).

Conclusions  The study supports the business case for payers, particularly Medicaid, to invest in postdischarge follow-up calls.

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Figure 1 ROI framework, components, inputs, data sources, and calculationsa

a Data source where not otherwise specified: 2006–2011 Truven Health MarketScan Commercial Claims and Encounters Database and 2006–2011 Truven Health MarketScan Multi-State Medicaid Database. ROI, return on investment. [See online data supplement for the working model.]

Figure 2 One-way sensitivity analysis of the ROI for follow-up calls after discharge from a hospital for individuals with commercial insurance and Medicaida

a Inputs listed at left were varied by ranges that were ±2 SEs or hypothetical variances from the mean base case values listed in Table 1. The resulting return on investment (ROI) for the minimum and maximum values is shown in the tornado diagram on the right. When all inputs are at their mean base case value, the mean ROI is $1.76 for commercial insurance (light gray vertical line) and $2.43 for Medicaid (dark gray vertical line). The only input that crosses the break-even point of $1 is the effect of follow-up calls on reducing readmissions. The ROI will be >$1 as long as the effect is ≥12.9% for commercial insurance and ≥9.3% for Medicaid. [See online data supplement to conduct additional sensitivity analyses.]

Figure 3 One-way sensitivity analysis of the ROI for follow-up calls after discharge from an emergency department hospital for individuals with commercial insurance and Medicaida

a Inputs listed at left were varied by ranges that were ±2 SEs or hypothetical variances from the mean base case values listed in Table 1. The resulting return on investment (ROI) for the minimum and maximum values is shown in the tornado diagram on the right. When all inputs are at their mean base case value, the mean ROI is $1.70 for commercial insurance (light gray vertical line) and $2.05 for Medicaid (dark gray vertical line). The only input that crosses the break-even point of $1 is the effect of the intervention on reducing readmissions. The ROI will be >$1 as long as the effect is ≥13.3% for commercial insurance and ≥11.0% for Medicaid. [See online data supplementto conduct additional sensitivity analyses.]

Anchor for Jump
Table 1Inputs for the calculation of the return on investment for postdischarge follow-up calls, by place of discharge and payer
Table Footer Note

a Hypothetical variances around the mean that are 10% of the base case value

Table Footer Note

b Hypothetical variances around the mean created by the difference between the base case value and its minimum potential value (0%) divided by two

Table Footer Note

c Hypothetical variances around the mean created by the difference between postintervention and baseline follow-up treatment rates divided by two

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