Community health worker model return on investment - a meta-analysis and in depth case study

While CHWs have generally focused on outreach and mobilization, at our study site, the critical role needed was care management. It has been common to have nurses do care management, but the Departmental Chair ruled out the nurse case-manager model because it was too costly and problematic at best for the patient population seen at their family medicine practice in the South Bronx. Nurses were not likely to be from the community, and, if so, they would be hard to find. Emerging evidence had pointed to the improved efficiencies of peer support for care management; therefore, the Departmental Chair opted for the CHW model. Hence, the primary role for the CHWs was to be care management. Financial data from available studies were assembled to generate return on investment (ROI) calculations for CHWs. These ROI were calculated by the authors of the studies cited or by our own group using standard ROI methodology. The return on investment ratio is calculated by comparing the annual cost per patient provided CHW support against the comparable costs per patient without the CHW. The average ROI for these 10 case studies for which sufficient cost data were supplied was 3.20, ranging from 1.15 up to 6.10. The data clearly show that Health Homes can achieve the desired outcomes of improved patient outcomes at lower cost by using CHWs. Across the board, the savings generated by the CHWs more than pays for their total cost, and on average by 3 times their total cost.