Where Is the Break-even Point for Community Health Workers? Using National Data and Local Programmatic Costs to Find the Break-even Point for a Metropolitan Community Health Worker Program

Authors: Gurley-Calvez T and Williams J
Year: 2020
State: NatDoc: National Document
Website link: https://pubmed.ncbi.nlm.nih.gov/32197027/
Publicly Available: No
Billing and Reimbursement:
Evidence Generation:
Sustainable Financing: General other, Documentation of how CHWs can work within care teams, ROI and bundled payment successes/challenges
Workforce Development: Data sharing between social services and clinical teams, General other (including mention of “employment practices”)

Background: Community health worker (CHW) programs take many forms and have been shown to be effective in improving health in several contexts. The extent to which they reduce unnecessary care is not firmly established.

Objectives: This study estimates the number of hospitalizations and emergency department (ED) visits that would need to be avoided to recoup program costs for a CHW program that addressed both medical and social needs.

Research design: A programmatic cost analysis is conducted using 6 different categories: personnel, training, transportation, equipment, facilities, and administrative costs. First, baseline costs are established for the current program and then estimate the number of avoided ED visits or hospitalizations needed to recoup program costs using national average health care estimates for different patient populations.

Measures: Data on program costs are taken from administrative program records. Estimates of ED visit and hospitalization costs (or charges in some cases) are taken from the literature.

Results: To fully offset program costs, each CHW would need to work with their annual caseload of 150 participants to avoid almost 50 ED visits collectively. If CHW participants also avoided 2 hospitalizations, the number of avoided ED visits needed to offset costs reduces to about 34.

Conclusions: Estimates of avoided visits needed to reach the break-even point are consistent with the literature. The analysis does not take other outcomes of the program from the clients’ or workers’ perspectives into account, so it is likely an upper bound on the number of avoided visits needed to be cost-effective.