Table 2 shows a cost savings of $170,875.000 on a randomized chart review of 50 cases in the 0-5 age group.  The charts were reviewed for utilization of emergency room walk-in and hospitalization six months prior to NCM intervention and utilization six months after intervention.  The findings after NCM intervention are significant, there was a 87% decrease in Emergency Department (ED) visits, a 77% decrease in Walk-In (WI) visits, and 84% decrease in hospital admissions.  The same utilization criteria was used for a second chart review (Table 3) on a sample of 39 cases in the 1-11 age group who attended health education sessions provided by our health educators and showed a cost savings of $20,925.00.  

Table 2:  Age Group:  <5 years of age  
Asthma Program Cost Analysis Report  
Total patients case managed by RN for at least six months:  50  
 

Before Case Management	After Case Management
ED Visits WI Visits Admissions avg LOS=3 # Visits 130 133 69 Cost per 185.44* 74.40* 2,454.00** Total 24, 107.20 9,895.20 169,326.00	ED Visits WI Visits Admissions avg LOS=3 # Visits 17 31 11 Cost per 185.44 74.40 2,454.00** Total 3,152.48 2,306.40 26,994.00
GTotal $203,328.40	GTotal $32,452.88

 Cost Savings r/t case management:  $170,875.52 
  
 Table 3:  Age group: 1-11 years of age  
Patients who only attended  Asthma Education Sessions  
Sessions Conducted by Health Educators, no RN case management  
 Total number of patients:  39 

Before Asthma Class	After Asthma Class
ED Visits WI Visits Admissions avg LOS=3 # Visits 21 52 6 Cost per 185.44* 74.40* 2,454.00** Total 3,894.24 3,868.80 14,724.00	ED Visits WI Visits Admissions avg LOS=3 # Visits 2 16 0 Cost per 185.44 74.40 2,454.00** Total 370.88 1,190.40 0
GTotal $22,487.04	GTotal $1,561.28

 Cost Savings r/t Asthma Education ONLY:  $20,925.76  
 Source:  * FHC Billing:  January-June 1996 Cost Analysis Report  
 **1995 LMC ICR Cost Report  

The interventions provided by the AEP have been so successful, that the targeted age group has been expanded to the 1-21 age range.  The AEP will continue to perform chart reviews on utilization before and after intervention to measure outcomes in 1997.  In an attempt to project future cost savings, 1,219 enrolled Health Plus (capitated patients) age 0-18 with the diagnosis of asthma was identified.  In 1995, these patients averaged 10.75 visits per patient in the ambulatory care setting costing the FHCN an estimated $1,359,929.  Applying the experience gained using case management and health education by the AEP team, a 30% reduction in unscheduled visits and hospitalizations would generate a cost savings of $407,978.