The return on investment of postdischarge follow-up calls for suicidal ideation or deliberate self-harm

Psychiatr Serv. 2014 Aug 1;65(8):1012-9. doi: 10.1176/


Objective: Transitions of care are critical for individuals at risk of suicide. This study determined the return on investment (ROI) for providing postdischarge follow-up calls to patients at risk of suicide who are discharged from a hospital or an emergency department.

Methods: Claims data were from the 2006-2011 Truven Health MarketScan Commercial Claims and Encounters Database and Multi-State Medicaid Database. Cost estimates were from eight call centers that provide postdischarge follow-up calls. The ROI was estimated for the 30 days after discharge and was calculated from a payer's perspective (return gained for every $1 invested). One-way and probabilistic sensitivity analyses were used to examine the influence of variations of ROI model inputs.

Results: Under base case assumptions, the estimated ROI was $1.76 for commercial insurance and $2.43 for Medicaid for patients discharged from a hospital and $1.70 for commercial insurance and $2.05 for Medicaid for those discharged from an emergency department. Variation in the effect size of postdischarge contacts on reducing readmission had the largest effect on the ROI, producing a range from $0 to $4.11. The ROI would be greater than $1 for both payers and across both discharge settings as long as postdischarge contact could reduce readmission by at least 13.3%. Sensitivity analyses indicated a 77% probability (commercial) and an 88% probability (Medicaid) that the ROI would be greater than $1 among hospital discharges; the probabilities among emergency department discharges were 74% (commercial) and 82% (Medicaid).

Conclusions: The study supports the business case for payers, particularly Medicaid, to invest in postdischarge follow-up calls.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Continuity of Patient Care / economics*
  • Cost-Benefit Analysis / economics*
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Medicaid / economics*
  • Patient Discharge / statistics & numerical data*
  • Self-Injurious Behavior / economics*
  • Self-Injurious Behavior / therapy
  • Suicidal Ideation*
  • United States