TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Benchmarking/statistics & numerical data
KW - Chronic Disease/economics/therapy
KW - Community Health Workers/economics/organization & administration
KW - Cost-Benefit Analysis
KW - Emergency Service, Hospital/economics
KW - Female
KW - Health Services/economics/utilization
KW - Hospitalization/economics/statistics & numerical data
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Econometric
KW - Primary Health Care/organization & administration
KW - Young Adult
AU - S. Basu
AU - H. E. Jack
AU - S. D. Arabadjis
AU - R. S. Phillips
A1 - 
AB - 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.
BT - Medical care
C5 - Education & Workforce; Financing & Sustainability
CP - 2
CY - United States
DO - 10.1097/MLR.0000000000000618
IS - 2
JF - Medical care
N2 - 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.
PP - United States
PY - 2017
SN - 1537-1948; 0025-7079
SP - 140
EP - 147
EP - 
T1 - Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis
T2 - Medical care
TI - Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis
U1 - Education & Workforce; Financing & Sustainability
U2 - 27547954
U3 - 10.1097/MLR.0000000000000618
VL - 55
VO - 1537-1948; 0025-7079
Y1 - 2017
ER -