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Cost of Delivering Centralized and Decentralized Reminder/Recall for Vaccinations to Children and Adolescents in an ACO
Melanie D. Whittington, PhD; Dennis Gurfinkel, MPH; Laura P. Hurley, MD; Steven Lockhart, MPH; Brenda Beaty, MSPH; Miriam Dickinson, PhD; Heather Roth, MA; and Allison Kempe, MD, MPH
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Cost of Delivering Centralized and Decentralized Reminder/Recall for Vaccinations to Children and Adolescents in an ACO

Melanie D. Whittington, PhD; Dennis Gurfinkel, MPH; Laura P. Hurley, MD; Steven Lockhart, MPH; Brenda Beaty, MSPH; Miriam Dickinson, PhD; Heather Roth, MA; and Allison Kempe, MD, MPH
Centralized reminder/recall (R/R) is less costly to deliver than decentralized R/R for both children and adolescents when implemented for patients within an accountable care organization.
ABSTRACT

Objectives: Within an accountable care organization (ACO), we compare the investment needed to deliver reminder/recall (R/R) for childhood and adolescent vaccinations via 2 approaches: (1) centralized R/R with messages delivered to all patients of the ACO by a single organization versus (2) decentralized R/R with messages delivered to ACO patients by their primary practice.

Study Design: A cost analysis was conducted to calculate the total cost of initiating and implementing centralized and decentralized R/R.

Methods: Domains of resource use included collaboration, training, and recall. Personnel time was monetized using standardized federal wage rates for each occupation. Nonpersonnel resources were calculated using invoices for R/R activities. Start-up and implementation costs were stratified by approach (centralized and decentralized) and population (child and adolescent).

Results: Of the 11 practices that agreed to participate in decentralized R/R for children at their practice, just 1 conducted R/R. Similarly, of the 15 practices that agreed to participate in decentralized R/R for adolescents at their practice, just 5 conducted R/R. This study found that start-up costs for R/R were similar across approaches ($1366 for centralized and $1300 for decentralized), but implementation costs differed. For R/R in children, implementation costs were more than twice as much for decentralized R/R ($3.92 per child recalled) than for centralized R/R ($1.78 per child recalled). Similarly, the cost of R/R for adolescents was $1.37 per adolescent recalled in decentralized R/R and $0.78 per adolescent recalled in centralized R/R.

Conclusions: Centralized R/R within an ACO was less costly than decentralized R/R and resulted in more patients being reached.

Am J Accountable Care. 2018;6(4):19-25

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