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This book offers a comprehensive overview of performing return-on-investment (ROI) analyses for healthcare quality improvement (QI). In the United States, healthcare policy regarding physician and facility payment/reimbursement is steadily trending towards the use of "value-based" systems and away from the traditional "fee-for-service" (FFS) payment mechanisms. Healthcare professionals and organizations who have previously focused on quality metrics are now finding themselves burdened with having to define and assess value metrics, without much guidance or assistance. This volume aims to be a guide and a reference for healthcare professionals tasked with estimating and establishing ROI for QI.
Chapters describe the general framework for how to perform QI; establish standard definitions of important terms, concepts, and calculations; and provide specific instructions for how to complete each step of an ROI analysis. These include: selecting a QI initiative and identifying the associated metrics, establishing measurable, monetizable, and attributable costs and benefits, determining the appropriate scope and perspective, calculating ROI and related metrics (payback period, benefit-to-cost ratio, etc.), comparing with established benchmarks or previously published results, and interpreting the results for the intended audience. In addition, chapters offer examples of real studies (or hypothetical studies of real situations), as well as templates for several of the necessary activities that readers can leverage for their own use.
Return on Investment for Healthcare Quality Improvement is a must-have resource for healthcare providers, administrators, and other professionals who work in healthcare organizations, hospitals and other healthcare settings, health systems, and residency programs seeking to obtain outside funding, as well as policy makers and administrators of federal programs. 

Return on Investment for Healthcare Quality Improvement

Chapter 1. Introduction1.1 The Current Healthcare Environment1.1.1 Funding Requirements for Those Looking to Improve Care Quality1.2 Concepts of Value in Quality Improvement1.2.1 A Discussion of "Value" in Health Care1.2.2 The Journey of Understanding Value in Relation to that of Quality1.3 Quality Improvement as an Exercise in Influence1.4 Return on Investment1.4.1 How ROI is Used in Other Industries1.4.2 How We Will Define ROI1.4.3 Unique Challenges for Examining ROI in the Healthcare Setting1.4.4 Differences in Prospective Versus Retrospective Analyses of ROI1.5 Who this Book Is For1.6 Chapter Summary1.7 Key ConceptsReferences
Chapter 2: Planning an ROI Analysis2.1 The Motivation to Assess Value in Health Care2.2 The Critical Aspects of Quality Improvement2.2.1 Defining Quality2.2.2 Measuring Quality2.2.3 Assessing and Evaluating Quality2.3 Measuring Value2.3.1 Considering What Can Be Improved, Measured, and Monetized2.3.2 Planning the Value Assessment in Tandem with the Quality Assessment2.4 Definitions and Terms2.4.1 ROI2.4.2 Benefit-to-Cost Ratio (Benefits per Dollar Spent) 2.4.3 Savings per Patient2.4.4 Payback Period2.4.5 Other Metrics2.5 Basic ROI Design2.5.1 Scope and Perspective2.5.2 Costs and Benefits2.5.3 Base Case and Sensitivity Analyses2.5.4 Interpretation2.6 Hypothetical Case Studies2.6.1 Example 1: Nursing Home Falls2.6.2 Example 2: Improved Hospital Discharge Process2.6.3 Example 3: Introducing a Collaborative Care Model2.6.4 Example 4: Investing in Facility Improvements2.7 Chapter Summary2.8 Key ConceptsReferences
Chapter 3: Initial Steps3.1 Define Scope and Perspective3.1.1 Perspective3.1.2 Scope3.1.3 Practical Examples of Defining the Scope and Perspective3.1.4 Major Assumptions and Their Implications3.2 Determine What to Measure3.2.1 Process Versus Outcome Measures3.2.2 Individual Versus Composite Measures3.2.3 One Versus Many Measures3.2.4 The Impact of Project Characteristics on Measures3.3 How to Select Quality Improvement Opportunities for Value3.3.1 Questions to Ask3.4 How to Estimate the Expected Effectiveness and Associated Value3.4.1 Pulling from Your Own Experience3.4.2 Pulling from Published Literature3.5 Secure Buy-In and Recruit Partners3.6 Chapter Summary3.7 Key Concepts
Chapter 4: Costs and Benefits4.1 The Impact of Scope and Perspective on Costs and Benefits4.2 Costs4.2.1 Identifying Cost Sources4.2.2 Estimating and Monetizing Costs4.2.3 Aggregating Costs4.3 Benefits4.3.1 Measurable, Monetizable, and Directly Attributable Benefits4.3.2 Estimating MMA Benefits4.3.3 Estimating Non-MMA Benefits4.3.4 Calculating Benefits (Formulas) 4.4 Discounting4.5 Chapter Summary4.6 Key ConceptsReferences
Chapter 5: Performing Base Case and Sensitivity Analyses5.1 Prospective versus Retrospective ROI Analyses5.2 Developing the Base Case Scenario5.2.1 General Considerations for the Base Case5.2.2 Identifying Usable Estimates5.2.3 Applying the Perspective and Scope to the Base Case5.2.4 A Base Case Example5.3 Sensitivity Analysis5.3.1 General Considerations for the Sensitivity Analysis5.3.2 Creating Best- and Worst-Case Scenarios5.3.3 Identifying What to Vary in the Sensitivity Analysis5.3.4 Adding in Non-MMA Benefits5.3.5 Adding Other Forms of Value5.4 Uncertainty and Alternatives5.4.1 Identifying Key Assumptions5.4.2 Assessing How Much Key Assumptions Could Vary5.4.3 Estimating the Potential Impact of Assumptions and Estimates5.4.4 Exploring Alternatives to Assumptions5.5 Chapter Summary5.6 Key Concepts
Chapter 6: Interpretation and Presentation6.1 Exploring the Background and Project Motivation6.1.1 Methods for Providing Appropriate Background6.2 Interpreting ROI Analysis Results6.2.1 Interpreting ROI Values6.2.2 Interpreting the Benefit to Cost Ratio (BCR) 6.2.3 Interpreting the Payback Period6.2.4 Interpreting Savings per Patient6.3 Extrapolating and Generalizing Results6.3.1 Generalizing to Other Settings6.3.2 Extrapolating the Effect of a Change in Scope6.3.3 Extrapolating the Effect of the Intensity of the Intervention6.3.4 Extrapolating to Different Populations6.4 Developing a Full Report to Present Results6.4.1 Ensuring the Key Information Is Reported6.4.2 Effectively Presenting the Essential Information6.5 Chapter Summary6.6 Key ConceptsReferences
Chapter 7: Hypothetical Case Studies7.1 Example 1: Reducing Nursing Home Falls7.1.1 Sample ROI Analysis7.2 Example 2: Improving the Discharge Process7.2.1 Sample ROI Analysis7.3 Example 3: Introducing a Collaborative Care Model7.3.1 Sample ROI Analysis7.4 Example 4: Investing in Facility Improvements7.4.1 Sample ROI Analysis7.5 Comments about the hypothetical examples
Chapter 8: Tips and Templates8.1 Tips8.1.1 Accessing Relevant Information8.1.2 Presenting ROI Results in Oral Presentations8.1.3 Responding to a Request for Proposals (RFP) 8.1.4 Publishing and Disseminating Results8.1.5 Develop a Process8.1.6 Increasing Influence8.2 Templates8.2.1 Literature Abstraction Template8.2.2 Outline and Checklist Templates8.2.3 Costs8.2.4 Benefits8.2.5 Calculations of Base Case and Sensitivity Analyses8.3 Chapter Summary8.4 Key Concepts
Chapter 9: Expanded Topics in ROI9.1 ROI in a Value-Based Environment9.1.1 Reducing Encounters Versus More Efficient Encounters9.1.2 Benefits Across Care Settings9.1.3 Benefits Associated with Quality Monitoring Programs9.1.4 The Impact of Social Media9.1.5 Putting It All Together9.2 Life Years and Quality-Adjusted Life Years (Cost-Effective and Cost-Utility Analysis) 9.2.1 Background9.2.2 Relationship to ROI9.3 Deterministic and Probabilistic Sensitivity Analysis9.4 Contingent Valuation9.5 The Changing Landscape of Quality Improvement9.5.1 The Evolution of Care Delivery9.5.2 Implementation Science and Emerging Methodologies9.5.3 Where Does ROI Fit In? 9.6 ROI in Statistical Process Control9.7 Chapter Summary9.8 Key ConceptsReferencesGlossary of Terms