Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health worker (CHW). CHWs take on a variety of roles to help patients. Working in emergency departments or in disease-specific education are the most prevalent.
What do CHWs do?
In the CHW program at KC CARE in Kansas City, for example, community health workers advocate for community members. They help connect them to health and social services. CHWs address proper care for chronic conditions, social determinants of health, and help enroll patients in assistance programs. Patients are referred by a primary care provider, emergency department, community organizations, or they may self-refer.
In 2018, 56,130 CHWs were hired in the United States alone. The hype around CHWs has led many to ask if the approach is worth adopting. With the new emphasis on value-based care adopted by the Centers for Medicare & Medicaid Services (and covered before on this blog), there is more room to test the value of such models.
Is there a financial break-even point?
Drs. Gurley-Calvez and Williams recently published an article in Medical Care that estimated the financial break-even point for investments in CHWs through avoided emergency department admissions. Each avoided emergency department visit was worth about $1,375 to $2,417. An avoided emergency visit was considered a return on investment. The authors use the CHW program at the KC CARE clinic to determine the breakeven point for this program that could be used as a model for others.
The authors conclude that each CHW costs $68,621 at KC CARE. These costs include personnel, training, transportation, equipment, facilities, and administrative costs. They estimate that 28 avoided emergency department visits would fully offset the cost of one CHW. This is for uninsured populations that would be charged an average of $2,417 per visit. When looking at the typical cost of an emergency department visit for a population such as the one that KC CARE serves, just eight avoided visits would offset the cost. This is due to having many patients with high-cost health conditions like diabetes.
Is the financial break-even point the same everywhere?
The article notes that the cost per CHW program varies on the geographical location and services provided. The authors use California and New York as references for high cost of living. Cities with higher costs of living require fewer avoided emergency department visits to offset costs. As a result, a CHW program in Kansas City requires more avoided visits to break even because health care is generally cheaper.
The authors suggest that CHWs could be a cost-efficient option if they can help reduce emergency department visits, especially among frequently flyers. They do this by addressing the disconnect between the health care system and community members. Although funders may or may not see the desired return on investment immediately or ever, there is value in the lives the programs impact.
Jennifer Oliveira
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