Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis
An Evidence-Based Practice
Description
This study estimates 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 using a microsimulation of patient health care utilization, costs, and revenues. 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.
Goal / Mission
The goal of this study is to determine how many Community Health Workers (CHW) would be needed to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective.
Impact
This study adds significant knowledge to the existing literature on CHW programs, and particularly provides critical information to payers that can be used for making decisions on appropriate payment models
Results / Accomplishments
The level of reduction in ED visits and associated inpatient hospitalizations would vary substantially by the primary diagnosis for a patient. Achieving cost savings would require preventing 4 to 23 ED visits and associated hospitalizations per year among a panel of patients, representing a reduction of 3% to 21% in total ED visits. For example:
A CHW with a caseload of 70 asthma patients would need to prevent about 14 ED visits (15% of the total), of which 23% would be expected to result in a hospitalization.
A CHW with a caseload of 70 heart failure patients would need to prevent about 4 ED visits (3% of the total), of which over 90% would be expected to result in hospitalization.
A CHW with a caseload of 70 asthma patients would need to prevent about 14 ED visits (15% of the total), of which 23% would be expected to result in a hospitalization.
A CHW with a caseload of 70 heart failure patients would need to prevent about 4 ED visits (3% of the total), of which over 90% would be expected to result in hospitalization.
About this Promising Practice
Topics
Health / Other Conditions
Health / Health Care Access & Quality
Community / Community & Business Resources
Health / Health Care Access & Quality
Community / Community & Business Resources
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