Calculating the Cost of Care Coordination

A quick and dirty guide to estimation

Deborah Allen, ScD

Catalyst Center

Boston University School of Public Health

Assumptions

Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally

Any child or youth with special health care needs may need access to care coordination at some time

An organized, statewide system of care coordination is the only way to assure universal access

Care coordinators can effectively serve children and adolescents with a range of disabilities or chronic conditions

– At least at a baseline level

Relevant variables

The number of children with special health care needs in the state

The caseload per FTE care coordinator per year

The salary per FTE care coordinator per year

The number of children with special health care needs in WA

2000 Census: 1,513,843 under age 18 Of whom 13.7% reported to have special

health care needs on the National CSHCN Survey

That means 207,396 children with special health care needs

For purposes of estimation: 200,000 children with special health care needs

The caseload per FTE care coordinator

Depends on model and case mix Washington has 500 pediatricians -> average pediatric

panel of 3,000 children If assume 1 FTE care coordination per average pediatric

panel of about 3,000– Each care coordinator is available to about 400 children with special

health care needs, of whom 80 will probably require ongoing support

– System requires 500 care coordinators If assume 1 FTE care coordinator can only serve 200

children of whom 40 will require ongoing support– System requires 1,000 care coordinators

Implications of a compromise figure

If, 1 care coordinator can serve a total caseload of 300 children with special health care needs

Of whom 60 will require ongoing support– Development of a care plan– Bi-weekly check-in with family– One annual visit to school or home

Estimate 120 days/year spent on these 60 children

– 140 days/year spent on remaining 240 children

-> 750 care coordinators needed to serve child population of WA

Washington labor market salaries

For nurse manager $37.75*

For staff nurse $30.54

For health educator $24.22

For medical/public health social

worker $23.45

For child and family social worker $17.62

For medical assistant $14.67

Annual salary

At hourly rate of $35 $72,800 At hourly rate of $25 $52,000 At hourly rate of $15 $31,200

System costs for 750 care coordinators with benefits

Advanced practice RN $68,250,000 Social worker

$48,750,000 Certified paraprofessional

$29,250,000 Plus estimated $1,000,000 system oversight

costs Cost is between $30 and $70 million!

BUT

Cost per child – Range is $19 to $46/year

Cost per child with special health care needs– Range is to $150 to $350/year

System savings if each care coordinator averts two major hospitalizations per year $37,500,000