CASE STUDY: Evaluation of Proposed Federal Legislation
Challenge
VSC was engaged by a consortium of patient-advocacy organizations to develop a preliminary score (a measure of financial impacts) for legislation that would require public and private insurers to reimburse enrollees for costs associated with medical foods necessary to manage certain digestive and inherited metabolic disorders. Several states had passed legislation mandating medical-foods coverage under varying agreements, complicating isolation of the remaining federal and private spend. Given the complexity, VSC’s client expressed concern that economists could misestimate relevant costs, potentially jeopardizing passage of the legislation and leaving patients with burdensome medical expenses and providers with few affordable treatment options. VSC was selected from numerous consultancies to provide a comprehensive financial estimate of the budgetary impact of this legislation on public and private health care programs, which would illustrate the value of medical nutrition coverage to patient advocates, Bill sponsors, committee members, and congressional staff.
Intervention
VSC thus applied a mixed-methods approach to assess the cost and value of the legislation. An extensive literature review was conducted to establish benchmark data on cost and utilization by disorder. Quantitative techniques, combined with reviews of state legislation and associated cost methodologies, estimated the financial cost of the bill, net of the cost of existing state-mandated programs. Qualitative analysis of key informant interviews with specialists, identified common clinical pathways, barriers to and strategies for accessing medically necessary foods.
Results
Our quantitative methodologies, current cost estimates, and 10-year forecasts were shared with economists to guide their independent legislation scoring; Bill sponsors and staffers were briefed. The clients were satisfied that forecasts sufficiently accounted for existing state expenditures on similar programs and therefore represented a fair estimate of bill costs. The legislation and respective bill are currently under Subcommittee review.