1. Determining Your Program’s Health and Financial Impact Using EPA’s Value Proposition Brenda Doroski, Director Center for Asthma and Schools U.S. Environmental Protection Agency 1

2. Session Goals Demonstrate the value of a holistic, coordinated program approach to link health and housing Identify best practices for strengthening partnerships and leveraging community assets to improve coordinated program delivery and sustainability Understand the key components to developing a Value Proposition 2

3. Asthma and the Healthy Homes Connection The Heath Care Landscape Challenges and One Solution o Leading by Example – Award Winners Introduction of the Value Proposition Building a Value Proposition Tools & Resources Next Steps Your Thoughts Agenda Housekeeping Timekeeping Post Your Questions and Suggestions Have Fun! 3

4. The Health Care Landscape Movement from reactive to proactive health management Well-defined and accepted role of the environment and its relationship to asthma New opportunities for the Affordable Care Act and Medicaid to help sustain comprehensive asthma care Federal government committed and united to proactively address asthma disparities o Asthma Disparities Action Plan o Advancing Healthy Housing – A Strategy for Action 4

5. Multiple programs are going into the home Asthma health outcomes may be used to assess the effectiveness of Healthy Homes programs Opportunity to maximize impact by providing a holistic, coordinated approach to addressing asthma o Partnerships & Collaboration o Community Assets Asthma and the Healthy Homes Connection 5

6. The Challenges and a Solution Funders face competing priorities resulting in limited funding Programs need to: o Demonstrate results-oriented programming o Differentiate themselves o Identify multiple funding streams for sustainability One Solution: Developing Your Value Proposition 6

7. What is a Value Proposition? Tool to help communicate unique program value and benefits to potential funders Demonstrates a program’s health outcomes and economic savings outweigh operating costs Effective means for securing future funding for new pilot projects and well-established programs 7

8. Benefits of a Value Proposition Crystallizes program value Opportunity to see program impacts on health outcomes by capturing costs, calculating health cost savings, and conducting a program evaluation 8

9. Example of a Value Proposition For $18,441, my program will reduce hospitalizations by 58 percent for 13 pediatric patients and will generate $257,230 in health cost savings over the next 3 years. - Asthma Network of West Michigan 9

10. Breaking Down the Value Proposition Working Session: Building Your Value Proposition 10

11. Key Components Target Populations Program Activities Health Outcomes Program Costs Healthcare Savings Elevator Pitch 11

12. Multnomah County Healthy Homes Location: Portland, Oregon Type: County government Goal: Create sustainable funding for healthy homes interventions Approach: Amend state health plan to provide targeted case management reimbursement for healthy homes and opportunities for other health departments to provide this service o Nurse Case Manager provides six months nursing case management/coordinates with pharmacy and medical o Community Health Worker provides environmental assessment, interventions, household supplies 12

13. Target Population State program’s focus populations to describe program capacity Questions o Who does your program target? o How many individuals can your program serve annually? Multnomah Example o Low-income families with children with asthma o 162 clients served annually 13

14. Program Activities Actions program plans to take to ensure targeted health outcomes are met Questions o What tasks or program activities will your program perform? o How will your program track and measure progress toward your activities? o What are your program’s performance targets? Multnomah Example o Number of clients served per year – 1134 visits o Percentage of clients with improved ACT or TRACK scores – 70% o Percentage of clients with reduced ER visits, # of visits saved – 50% o Percentage of environmental scores improved – 95% o Clients seen within the last 2 months – 90% 14

15. Health Outcomes Long-term impacts program promises to deliver to target population Questions o What are the long-term outcomes your program is after for your target population? o What is your program committed to achieving for your target population? Multnomah Example o Children participating in the Healthy Homes Program will use their medication correctly and have less visits to the ER. o Families will know how to reduce and mitigate asthma triggers in their homes allowing them to control their child’s asthma. 15

16. Program Costs Value Proposition should demonstrate program benefits outweigh operating costs o Management costs (20% of total program costs) o Program costs (70% of total program costs) o Evaluation costs (10% of total program costs) Multnomah Example o It will cost $197,920 (21%) to cover the management costs for my program. o It will cost $733,280 (78%) to cover the program activities costs for my program. o It will cost $10,000 (1%) to cover the evaluation costs for my program. o My program will cost $941,200 to implement my program for one year. We expect benefits of the program to last for two years. 16

17. Health Costs One important potential program benefit may be reduced medical costs (e.g., hospitalizations, ER visits) o Different than program costs, which are program operating costs Demonstrating health care savings is an effective way of getting funders to buy into Value Proposition Reducing medical costs may generate savings or be cost-effective investment for: o Managed care organizations, hospitals, insurers, health departments, grant makers 17

18. Health Costs (cont’d) Questions o How much does it cost to serve one individual in my target population? o How much does an ER visit cost for a typical asthma patient? o How much does a hospitalization cost for a typical asthma patient? 18

19. Health Costs (cont’d) Multnomah Example o By reducing Health Costs for my target population, my program will save $923,113 Cost to hospitalize one individual from my target population: $12,204. Number of hospitalizations prior to home interventions: 76 * $12,204 = $924,072 Number of hospitalizations post home interventions: 14 * $12,204 =$172,794 Hospital Cost Savings over 2 years: $751,252 *2 = $1,502,506 Cost to send one individual from my target population to the ER : $1116 Number of ER prior to home interventions: 199 * 1116 = 222084 Number of ER visits post home interventions: 37 * 1116 = 41292 ER Cost Savings over 2 years: $180,903* 2 = 361,807 Cost to serve my target population $941,200 o Health Cost Savings: $1,864,313- $941,200 = $923,113 *Calculations have been simplified for the purposes of the slide 19

20. The Elevator Pitch ‘Elevator pitch’ is a unique statement describing program It should quickly demonstrate to a potential funder that the program is powerful and worth funding Pitch should be tailored to resonate with each potential funder OPPORTUNITY: Practice Your Value Proposition with a health plan 20

21. Multnomah’s Elevator Pitch For $941,200, my program will reduce ER visits and hospitalizations by 100 percent for 162 pediatric patients in my community and will generate approximately $923,113 in health cost savings for my community over the next 2 years. 21

22. Tools and Resources 22

23. Value Proposition on the Network 23

24. Next Steps Visit AsthmaCommunityNetwork.org o Read the award winner case studies Continue working on your Value Proposition and visit the Value Proposition landing page Let us know if you’d like to participate in our Value Proposition case study Fill out an evaluation form and give us your feedback 24

25. Your Thoughts What questions do you have about the process for developing a Value Proposition? What excites you about developing a Value Proposition? Would you be willing to use AsthmaCommunityNetwork.org to continue conversations that are started here today? 25