Business Case / Return on Investment

Investing in programs that more effectively manage the care of high-risk, high-cost beneficiaries can improve health outcomes, reduce unnecessary utilization, and control Medicaid expenditures. Demonstrating that “quality pays” can help influence states, and health plans to invest resources in quality improvement initiatives. CHCS is working with Medicaid stakeholders to demonstrate return on investment for quality improvement and identify where financing realignment is necessary to support improvements in health care quality.

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Title and Description	Date	Type
Evaluation of the Business Case for Quality, Phase II This report outlines evaluation findings for the three BCQ II grantees. It also provides conclusions and examines the implications of BCQII for policymakers and other organizations wishing to implement programs that improve quality while providing a financial return.	May 2013	Reports
The Business Case for Quality in Medicaid – Still Searching for the “Slam Dunk” This policy brief summarizes BCQ II study findings and outlines lessons for designing Medicaid quality improvement efforts.	May 2013	Policy & Issue Briefs
Maximizing Quality and Value in Medicaid: Using Return on Investment Forecasting to Support Effective Policymaking This policy brief describes how Medicaid stakeholders can use return on investment analyses to support value-based purchasing decisions. The brief includes specific examples of how states can use ROI forecasts to support quality improvement efforts.	April 2009	Policy & Issue Briefs
User's Guide to the ROI Forecasting Calculator: Estimating ROI for Medicaid Quality Improvement Programs This how-to guide was developed to help Medicaid stakeholders use the ROI Forecasting Calculator for Quality Initiatives to generate forecasts for proposed quality improvement programs.	April 2009	Technical Assistance Briefs & Tools
Using Qualitative and Quantitative Methods to Evaluate Small-Scale Disease Management Pilot Programs This article by Mathematica Policy Research published in Population Health Management describes a multi-method approach for evaluating small interventions that participated in CHCS' Medicaid Value Program.	February 2009	Journal Articles
Business Case for Quality in Medicaid Managed Care - Final Grantee Evaluations As part of the final evaluation of CHCS' Business Case for Quality initiative, the University of North Carolina at Chapel Hill prepared individual reports detailing the results of each grantee's Quality Enhancing Initiative (QEI) and the associated return on investment.	January 2009	Reports
Demonstrating the Business Case for Quality in Medicaid: Challenges and Opportunities This study reports lessons from CHCS' Business Case for Quality (BCQ) initiative, a multi-site demonstration project evaluated by the University of North Carolina at Chapel Hill.	October 2008	Journal Articles
Forecasting Return on Investment for Medicaid Quality Initiatives: A CHCS Webinar During this CHCS webinar, CHCS demonstrated the ROI Forecasting Calculator for Quality Initiatives and participants in the ROI Purchasing Institute discussed how they used the tool to plan for and support specific state initiatives.	May 2008	Webinar Resources
Business Case for Quality: Phase II This initiative represents the second phase of CHCS' efforts to assess whether quality improvement activities can generate financial savings in excess of program costs for various stakeholders in the health care system.	April 2008	Initiative
Presentations from the Medicaid Purchasing Leadership Summit Download presentations from the Medicaid Purchasing Leadership Summit which brought together leaders from 15 state Medicaid agencies, health plans, and Medicaid policy experts to discuss best practices to improve health outcomes and control health care spending.	April 2008	Meeting Highlights
ROI Forecasting Calculator for Quality Initiatives The ROI Forecasting Calculator for Quality Initiatives is a web-based tool designed to help state Medicaid agencies, health plans, and other stakeholders assess and demonstrate the cost-savings potential of efforts to improve quality.	April 2008	Technical Assistance Briefs & Tools
Using ROI Forecasting to Maximize the Value of Medicaid Investments This issue brief profiles state experiences in using the ROI Forecasting Calculator for Quality Initiatives and outlines how ROI forecasting can help Medicaid stakeholders identify initiatives that improve health care quality while also controlling cost growth.	April 2008	Policy & Issue Briefs
Challenges to Using A Business Case for Addressing Health Disparities In this Health Affairs article the authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system.	March 2008	Journal Articles
Return on Investment Evidence Base: Identifying Quality Improvement Strategies with Cost-Saving Potential This technical assistance tool was developed to help Medicaid stakeholders identify quality improvement strategies with the potential to both improve outcomes and reduce health care costs. The tool includes studies on asthma, congestive heart failure, depression, diabetes, and high-risk pregnancy.	November 2007	Technical Assistance Briefs & Tools
Return on Investment Purchasing Institute May 2007 - June 2008	May 2007	Initiative
The Medicaid Return on Investment Template This tool is designed for use by states and health plans to retrospectively measure the ROI from quality improvement initiatives.	May 2007	Technical Assistance Briefs & Tools
Johns Hopkins Healthcare: Demonstrating a Return on Investment for Integrated Substance Abuse Treatment and Medical Care Management As a participant in CHCS' Business Case for Quality in Medicaid Managed Care initiative, Johns Hopkins Healthcare achieved cost savings and reduced hospital stays by combining medical and substance abuse case management for consumers.	September 2006	Case Studies
Business Case for Quality in Medicaid Managed Care June 2004 - December 2006	June 2004	Initiative