Cost Analysis of a Community Health Worker Program

Community health workers are front-line public health workers with a close understanding of the communities they serve. Community health worker (CHW) programs may take many forms and have been shown to be effective in improving health in several contexts, such as diabetes, cardiovascular disease, obesity, and cancer screening. However, the long-term sustainability of CHW programs is linked to the degree to which program costs are offset by program benefits. This manuscript uses cost information for a hub-and-spoke community health worker program run by KC Care, a clinic in Kansas City, Missouri, to estimate the number of ED visits and hospitalizations that would need to be avoided for the program to recoup program costs on a program level. The KC Care program has few restrictions on the target patient population or type of community resources, and a centralized administration with varied funding sources. CHWs in the program work with clients from several referral sources on a host of medical and social issues. At the time of analysis, the program included 24 CHWs and four supervisors working in the Emergency Departments (EDs) of five local hospitals, two internal clinic locations, and a county health department. Overall, the program considered in this analysis has a broader patient population, more work locations, and more significant integration of community services than programs previously evaluated in the peer-reviewed literature.

Data on program costs are taken from administrative program records and include a more comprehensive set of administrative costs than used in previous studies: fringe benefits, professional insurance, higher-level supervisors, and overhead costs. We drew estimates of ED visit and hospitalization costs (or charges in some cases) from the literature and adjusted for inflation using the Current Price Index Research Series Using Current Methods.

We estimated program costs in six different categories: personnel, training, transportation, equipment, facilities, and administrative costs. We calculated the all-inclusive cost of the CHW program to be $1,646,904 or an average of $68,621 per CHW. Because the program primarily draws low-income adults from the Kansas City metro area, we consider several possible measures of ED and hospitalization costs and charges drawn from previous work. Our estimates of the number of avoided ED visits needed to break even range from 14-50 per CHW per year. Separately, we estimated that 5-8 hospitalizations would need to be avoided per CHW per year to break even. Since combinations of ED visits and hospitalizations are the most likely outcomes of CHW programs, we also estimated the break-even point for specific combinations. For example, using one set of previous estimates, avoiding 9 ED visits and two hospitalizations would offset the cost of one CHW.

This study does not take other outcomes of the program from the clients' or workers' perspectives into account, so it is likely an upper bound on the number of avoided visits. Additionally, medical service costs are unlikely to capture the full societal benefit for a program that facilitates the use of community services such as food, housing, and employment assistance.