A Benefit-Cost Analysis of a Worksite Nurse Practitioner Program: First Impressions

• Published in: Journal of occupational and environmental medicine Vol. 47; no. 11; pp. 1110 - 1116
• Main Authors: Chenoweth, David, Martin, Nanette, Pankowski, Jared, Raymond, Lawrence W.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-2005; The American College of Occupational and Environmental Medicine; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Biological and medical sciences; Cost analysis; Cost-Benefit Analysis; Health Care Costs; Humans; Industry - economics; Legislation. Organization; Medical sciences; North Carolina; Nurse practitioners; Nurse Practitioners - economics; Occupational health; Occupational Health Services - economics; Occupational medicine; ORIGINAL ARTICLES; Program Evaluation; Public health. Hygiene-occupational medicine; Sick Leave - economics; Workplace; United States; North America; America; North Carolina; Occupational environment; Sanitary program; Company; Costs; Work place; Health center; Health staff; Health economy; Cost benefit analysis; Occupational medicine; Firm
• ISSN: 1076-2752; 1536-5948
• DOI: 10.1097/01.jom.0000182093.48440.4c

Objective: This study aimed to assess the initial impact of an on-site nurse practitioner (NP) initiative on the healthcare costs (HCC) among 4284 employees and their dependents. Methods: The authors analyzed HCC by two methods. First, they compared annualized actual values for the first 6 months of the startup year (2004) with those projected for 2004 on the basis of claims paid in 2002 and 2003. Both aggregate and per-individual HCC were used as the basis for comparison. The difference in HCC between projected and observed values for 2004 was defined as the benefit of the NP program. In a second analysis, HCC were calculated using 2003 paid claims for major diagnostic categories (MDC). These HCC were compared with those that would have been incurred had off-site care been used for the (annualized) number of such patients cared for by the NP in 2004 with the same MDC. The cost of the NP program was used as the denominator in calculating the benefit-to-cost ratio using the savings in HCC estimated by the two previously mentioned methods. Results: Annualized cost of the NP program was $82,716. Savings in HCC using the first method were $1,313,756 per year, yielding a benefit-to-cost ratio of 15 to 1. Using the MDC analysis, the ratio was 2.4 to 1. This difference in ratios between the two estimates may partly be attributable to effects of other initiatives such as the Wellness program and the Nurse Health Line. The latter was begun 10 weeks before the NP program, is available at all times, and is intended to minimize the need for workers and families to seek high-cost care at hospital emergency departments. Conclusions: The first 6 months of a new NP initiative yielded substantial reductions in HCC that warrant further analysis over longer periods of observation. However, the initial estimates may understate the aggregate value of the program because it may also reduce on-site injury and illness patterns and improve productivity, end points that were not assessed in this initial snapshot.