Sanjay Basu1, Helen E Jack, Sophia D Arabadjis, Russell S Phillips. 1. *Centers for Health Policy, Primary Care and Outcomes Research †Prevention Research Center ‡Center on Poverty and Inequality, Stanford University, Stanford, CA §Center for Primary Care, Harvard Medical School, Boston, MA ∥Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK ¶Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA.
Abstract
BACKGROUND: Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption. OBJECTIVES: To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective. RESEARCH DESIGN: Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources. RESULTS: CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4-5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure-approximately 3%-4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings. CONCLUSION: Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient's primary diagnosis.
BACKGROUND: Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption. OBJECTIVES: To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective. RESEARCH DESIGN: Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources. RESULTS: CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4-5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure-approximately 3%-4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings. CONCLUSION: Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient's primary diagnosis.
Authors: Savanna L Carson; Clemens Hong; Heidi Behforouz; Emily Chang; Lydia Z Dixon; Diane Factor; Sheba M George; Jenebah Lewis; Angelina Majeno; Maria Morales; Courtney Porter; Ami Shah; Stefanie D Vassar; Arleen F Brown Journal: J Ambul Care Manage Date: 2022 Jan-Mar 01
Authors: Gerardo Moreno; Carol M Mangione; Chi-Hong Tseng; Melanie Weir; Rosaneli Loza; Lisa Desai; Jonathan Grotts; Eve Gelb Journal: J Am Geriatr Soc Date: 2021-03-12 Impact factor: 7.538