A COST-EFFECTIVENESS APPROACH TO CALCULATING SROI FOR INTEGRATED AND INTEROPERABLE HEALTH AND SOCIAL SERVICES IN A LOCAL HEALTH AND HUMAN SERVICES DEPARTMENT

Human Services;Social Return on Investment;Interoperability;Healthcare Leadership & Management

Mohit, BabakLeaf, Philip J. ;

Johns Hopkins University

关键词: Human Services;    Social Return on Investment;    Interoperability;    Healthcare Leadership & Management;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/37933/MOHIT-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

BackgroundHuman services and welfare systems are essential elements of modern day societies.When operated efficiently, they provide a safety net for citizens who are unable to provide for themselves.Traditionally, the development of these programs has been independent of each other and each has its own separate legacy system of funding mechanisms, legal frameworks, management, bureaucracy, and information systems.However, overlaps in the scopes of these programs allow for redundancies and ultimately waste of program resources, and result in under coverage of their target populations, and at times the growth of social disparities and inequalities- exactly the opposite of what these programs were designed to reduce.With the rapid growth of information technologies (IT) and electronic communication networks, interoperability has emerged as a potential solution to the problem of silo welfare programs.Local health and human services departments are being encouraged to adopt a ;;no wrong door” approach under which their clients, regardless of the service the client applies for, can receive an array of needed services.The Intensive Case Management Calculator (ICMC) uses a cost effectiveness approach to calculate the Social Return on Investment (SROI) of the implementation of interoperable health and human services systems.MethodsThe ICMC, as developed, uses six specified personas, interviews with county healthcare executives, and a systematic literature review to gather evidence on the costs and benefits of the implementation of interoperability (To Be) and the lack of interoperability (As Is).The six personas represent complicated cases that use multiple services, and would potentially benefit the most from interoperability.These include ;;A child aging out of disabilities program’, ;;A pregnant teenager’, ;;A child aging out of foster care programs’, ;;A homeless young adult’, ;;A homeless family’, and ;;A homeless adult’.The ICMC employs a decision-tree-based model to compare the expected costs and benefits and to calculate the value added from interoperability.For a complete social perspective required for a Social Return on Investment (SROI) model, the ICMC considers three perspectives: client, social direct, and social indirect in addition to a total social perspective.The ICMC also performs a sensitivity analysis of the results, in addition to baseline costs and benefits.In order to test therobustness of the ICMC in accommodating various personas, after the development of the original ICMC, a modified ICMC was developed and tested witha newly created persona of ;;A victim of domestic violence’ replacing the persona of ;;A child aging out of disabilities program.’The use of the modified ICMC allowed for the external verification and the retrofitting of the ICMC.ResultsThe base-case analysis shows that, with the exception of children aging out of foster care, and the homeless youth personas, for all personas, an investment in interoperability is more costly than the alternative of no investment.However, from the total social perspective, the benefits of implementing interoperability exceed the costs for all personas.Beside the Homeless Family persona, the cost of implementing interoperability is below the chosen Willingness to Pay (WTP) threshold of $100,000 per client improved.The sensitivity analysis reveals broad ranges for the estimation of costs and benefits.Many of the cost ranges exceeded the WTP by multiples of ten or even one hundred folds.ConclusionSince the expected benefits of this investment are greater than the expected costs, and the expected costs per client ;;saved” are less than the WTP, investment in interoperability is prudent.Given the broad ranges of the sensitivity analysis results, careful, and continuous formative evaluation of the costs and the outcomes is highly recommended.Managers should give emphasis to the continuous evaluation of parameters that the sensitivity analysis deems may have the largest impact on the total investment results.