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Calculating ROI for Community Health Workers


An abundance of literature is emerging that touts the use of community health workers to further population health improvements. Many of the examples of success are anecdotal.

The scientific evidence is not abundant. There’s simply not enough data available yet to prove statistically that community health workers produce a return on investment (ROI). But, the data that is available shows that it is possible to have an ROI.

So, is the community health worker a key to success? Intellectually, we all agree that healthcare provider organizations have to go beyond caring for the sick. It’s not enough to say we are providing quality care – because that requires patients to show up and they are not. We have to go out, find these patients, and persuade them that it is in their best interest to see a healthcare provider. Then we have to make it easy for them to do so.
But how do we defend the cost of community health workers, especially when they only see a small fraction of health plan members?

The NCQA says that almost half of Medicaid managed care organizations struggle with getting members who are pregnant to attend vital prenatal appointments.
According to the CDC, in 2014, preterm birth affected about 1 of every 10 infants born in the United States. And there is a higher risk of serious disability the earlier a baby is born.

The March of Dimes reports that the average cost of a premature birth is $50,000 in the first year – compared to about $4,000 for a full term birth.
What’s the key to having more full term births? You know that answer. Data from the CDC, the March of Dimes and every other reputable source shows that women who get prenatal care give birth to full term, healthy babies.

And so here’s how you calculate ROI.

If you had 10 preterm births last year and you reduce that to 7 this year, you just saved $150,000 – and that’s just the savings for first year of care for preterm babies. It does not factor in care provided after the first year, which makes the return on investment even more compelling.
Cost savings is one way to show ROI. How about state and federal incentive compensation programs that increase or reduce revenue? Using the prenatal example, increasing the frequency of prenatal appointments and post-partum visits is critical to HEDIS scoring. It’s also good quality care and we all know that translates into more revenue through pay for performance bonuses.

Click the video to hear how Dasher explains how to calculate ROI for community health workers.

To learn more about Community Health Workers, visit any of these links below:

The website is for Nebraska Department of Health and Human Services



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