CHW Business Case
Previously known by many names, community health workers have played an essential role in helping people access health care services, embrace positive health behaviors, and navigate complicated treatment regimens for conditions such as cancer, diabetes, asthma and HIV/AIDS. The evidence base for CHWs is growing. An emerging body of research shows that CHWs can improve health outcomes, address health and health care disparities, and reduce health care costs by helping vulnerable and underserved populations access and navigate fragmented health and social services, make positive changes in their behaviors, and adhere to complicated treatment regimens.
For example, a number of studies of CHW programs have shown significant improvements in patients' use of prevention services, such as mammography and cervical cancer screenings among low-income and immigrant women.
A randomized controlled trial of a CHW intervention to increase insurance coverage among Latino children in Boston found that children in the CHW intervention group were significantly more likely to be insured and to be insured continuously, compared to children in the control group. Other studies also have shown that CHWs increased healthy food choices and increased physical activity among patients with diabetes, and clinical outcomes for diabetes, such as decreased A1C levels.
In addition to improved health outcomes, CHWs contribute to reducing health care costs by decreasing unnecessary or avoidable emergency department (ED) utilization and hospitalizations. An evaluation of the impact of CHWs on health care utilization of African-American Medicaid patients in Maryland with diabetes with or without hypertension showed a 40% reduction in ED visits, a 33% reduction in ED admissions to hospitals, a 33% reduction in total hospital admissions, and a 27% decrease in Medicaid reimbursements. The CHW program produced an average savings of $2,245 per patient per year and a total savings of $262,080 for 117 patients. A CHW intervention among underserved men in Denver, Colorado found that the CHW intervention shifted care from costly inpatient and urgent care to primary care services. This shift resulted in a return on investment of $2.28 per $1 spent on the community-based intervention for a total savings of $95,941 per year. Another evaluation of a community-based asthma management program showed a decrease in per capita expenditures from $735 to $18 (a 97.6% reduction), a reduction in ED visits from 60 to 10 (an 83.3% reduction) and an overall reduction in asthma-related visits from 1.5 to 0.25 per person after the CHW intervention.
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