A Medicaid Cost Savings Pilot Analysis of the Prevention and Access to Care and Treatment (PACT) Community Health Worker Intervention (Dorchester, Massachusetts)

Background Through a cadre of appropriately trained and supervised community health workers (CHWs), The PACT project collaborates with providers to provide holistic, individually-tailored, and culturally-appropriate home-based services to marginalized individuals living with HIV/AIDS who repeatedly fail standard care. Methods We conducted a pilot analysis of Medicaid claims data to ascertain cost savings as a result of the intervention. This includes 4 years of Medicaid medical expenditures for 16 patients to compare 2 years pre- vs. 2 years post- enrollment by major provider category: inpatient, outpatient, pharmacy, therapy and other. Patients considered received PACT services for a minimum of 12 months. Findings In addition to a majority of patients maintaining (52%) or improving (48%) their CD4 counts at 24 months, there is evidence of a decrease (-2.4%) in costs after the second year relative to the 12 months previous to the intervention. This means an overall 19.5% savings for the second year vs. the projected expenses for that year if the intervention had not been in place (assuming an 8% annual growth rate in overall Medicaid expenditures). A 40% decrease in inpatient services and a 30% increase in pharmacy costs, evidence of improved adherence, were also demonstrated. Interpretation The PACT model has the potential to empower patients to manage their HIV, improving clinical outcomes and optimizing healthcare utilization for one of the highest-cost populations served by Medicaid. Serving as a critical link between communities and the healthcare system, CHWs reduce reliance on costly medical services for episodes of acute, preventable illness.