Community Health Workers and cost savings
Peer Support and Community Health Workers (CHWs) Series:
Can CHWs integrated with primary care save cost?
Community health workers (CHWs) – known by a variety of names such as promotoras and peer supporters – are trusted sources of support that promote health and help people manage diseases. This is the 3rd post of a 3 part blog that takes a closer look at the 3 action steps that can help promote full participation of community health workers (CHWs) in patient-centered primary care and the promotion of Community Wellness provided in a recent article by Balcazar et al.
As discussed previously, there has been an increased recognition of CHWs in the last decade including by the National Institute of Medicine, US department of labor and the Affordable Care Act. This has led to more formal training programs for CHWs as discussed in part 2. However, when investing in training as well as applications for general funding there is a consistent need to demonstrate value. Although the value that CHWs provide in improving access to care and improved health outcomes can not be overstated, there is also a need to demonstrate the cost savings CHWs may have on the healthcare system. With that in mind, this 3rd blog takes a look at selected programs where the return on investment (ROI) and cost saving of CHWs has been demonstrated.
The Arkansas Community Connector program integrated CHWs into long-term care by finding community members in three disadvantaged Arkansas counties and connecting them to Medicaid home and community-based services. In a three year study involving nearly 2000 participants, those connected with CHWs reported a 23.8 percent average reduction in annual Medicaid spending per participant (Felix et al, 2012)
In Colorado, the Denver Health program is the primary healthcare “safety net” for underserved populations in Denver. They employ CHWs that provide a variety of services including community-based screening and health education, assistance with enrollment in publicly funded health plans, referrals, system navigation, and care management (Whitley et al., 2006). Over a 9 month period patients working with CHWs had an increased number of primary care visits and a decrease in urgent and inpatient care. This resulted in a $2.38 ROI for every dollar invested with the CHWs (Whitley et al, 2006).
In Kentucky, the Kentucky General Assembly authorized the Kentucky Homeplace Program in 1994. This program currently employs 39 CHWs, called family health care advisors, who provided services to 13,000 clients in 2007 across 58 predominately rural counties. The program received 2 million dollars in funding and in 2007 and was estimated to provide $15 to $20 of free or discounted medical services for every dollar invested (Goodwin & Tobler, 2008).
In Maryland, Baltimore CHWs working with diabetes patients on Medicaid achieved a 38% reduction in emergency room visits leading to a 27% drop in Medicaid costs for the patients. It was estimated that each community health worker was responsible for $80,000 to $90,000 dollars in savings by alternating weekly home visits and phone contacts (Fedder et al. 2003).
Although these 4 programs vary greatly in size and scope, they are all important in adding to a growing evidence base suggesting CHWs have the potential to provide substantial cost savings in the health care system. Further documentation of the financial impact of these programs can only serve to strengthen the argument for funding such programs. As CHWs continue to receive more recognition and the opportunity for more standardized training, demonstrating their financial impact will take on increased significance.
Balcazar, H., Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Matos, S., & Hernandez, L. (2011)
Fedder, D. O., Chang, R. J., Curry, S., & Nichols, G. (2003). The effectiveness of a community health worker outreach program on healthcare utilization of west baltimore city medicaid patients with diabetes, with or without hypertension. Ethnicity & Disease, 13(1), 22-27.
Felix, H. C., Mays, G. P., Stewart, M. K., Cottoms, N., & Olson, M. (2012). The care span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Affairs (Project Hope), 30(7), 1366-1374. doi:10.1377/hlthaff.2011.0150
Goodwin K., Tobler L. (2008). Community health workers. Issue Brief of the National Conference of State Legislators, 1–11
Whitley, E. M., Everhart, R. M., & Wright, R. A. (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor and Underserved, 17(1 Suppl), 6-15. doi:10.1353/hpu.2006.0015