These cases highlight Dr. Foldes’ ability to demonstrate results. They include a sophisticated analysis of health care costs using claims data, evaluations of behavior change projects, cost-effectiveness analyses of prevention, and an analysis of the appropriateness of emergency department use by Medicaid eligibles.
Case #6: Measure provider performance and cost
The company
- A major Minnesota health plan.
The challenge
- Assist the health plan in the midst of difficult contract negotiations with a nationally recognized multi-specialty provider group.
The solution
- Dr. Foldes designed, led and presented a methodologically rigorous comparative analysis of provider practice patterns and costs at a diagnosis-specific level, risk-adjusted and geo-coded to account for patient differences.
The result
- The presentation of results was credited with overcoming disparate perspectives on this group’s unique patient mix and practice patterns, helped contain reimbursement rates, and contributed to successfully negotiating the contract.
Case #7: Evaluate behavior change projects
The company
- A major Minnesota health plan engaging in prevention efforts to reduce tobacco use and exposure to secondhand smoke, increase physical activity and healthy eating.
The challenge
- On behalf of the health plan’s prevention group, design and implement a process to evaluate a wide range of community change projects funded by the health plan.
The solution
- Dr. Foldes worked closely with the prevention group leadership and project managers to design and implement a project evaluation process, and supervised the production of a series of successfully blended qualitative/quantitative evaluations carried out by internal evaluation staff and external contractors.
The result
- The project evaluations not only documented process indicators and outcomes but also clarified and strengthened many community change projects. The evaluation process improved strategic planning and decision-making for the prevention group’s work in communities.
Case #8: Document the cost-effectiveness of prevention
The company
- A major Minnesota health plan engaged in prevention efforts.
The challenge
- Document the value of prevention efforts on tobacco use and obesity.
The solution
- Dr. Foldes produced collaborative research to credibly document the health care cost savings of population based interventions to reduce tobacco use, and to project the future health care costs of obesity in Minnesota.
The result
- Presentations of the results helped build commitment to prevention efforts among senior executives and health plan board members by demonstrating the costs of these health risk behaviors and the savings resulting from intervention programs.
Case #9: Evaluate the appropriateness of emergency department visits
The company
- The state agency managing Minnesota’s Medicaid program.
The challenge
- Gather information on the use of the emergency department by Medicaid eligibles to help clarify the level of inappropriate use.
The solution
- Dr. Foldes formed a multi-disciplinary team to conduct on-site research in two large emergency departments using semi-structured interviews with Medicaid eligibles and organized physician reviews of medical records to determine appropriateness.
The result
- Study results demonstrated a surprising lack of consensus between physicians and patients on the “appropriateness” of visits, and also between physicians trained in internal medicine and emergency medicine. These results revealed the need to reconsider the definition of appropriateness in the emergency department setting. Results were published in the Annals of Emergency Medicine.
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