By addressing social determinants of health and coordinating care, community health workers help save Medicaid payers significant amounts of money, while also leading to better overall outcomes for patients, a new study asserts.
The findings could reasonably be applied to behavioral health providers. By offering preventative care to address social factors, the study suggests organizations could get ahead of patients’ budding behavioral health issues before they become more serious and more expensive down the line.
The study, which was published in the February edition of the journal Health Affairs, posited that these workers yielded Medicaid an annual return of nearly $2.50 for every dollar spent on patient services, which included mental wellness assistance.
Medicaid, a joint federal-state program that helps with health costs for the poor, spent more than $597 billion serving patients in 2018, according to the Centers for Medicare & Medicaid Services (CMS).
However, the study’s five-person research team — all of whom are faculty at the University of Pennsylvania’s Perelman School of Medicine — believe that the money could be better spent. Specifically, they advocate for more spending on community health workers, as opposed to using such funds only on enrollee treatment when they seek care.
Social determinants of health are economic, social and environmental factors that contribute to a person’s overall health status. Some examples include loneliness and inadequate access to housing and education, which have been linked to behavioral health problems like depression and anxiety. By helping people address their social determinants of health, community health workers can help prevent those conditions and others.
For the study, researchers conducted an economic analysis of more than 300 Philadelphia-area residents who received a variety of health services between 2013 and 2014.
Roughly half of those patients received support services from community health workers affiliated with the University of Pennsylvania. The workers frequently checked in on the patients and helped tailor treatment objectives to address their social and health needs.
One such example cited was of a patient who said she developed unhealthy eating habits as a way to cope with stress and was in need of a creative outlet. Subsequently, a community health worker helped her enroll in a pottery class at a senior center. Other community workers were instrumental in leading support groups for patients.
Patients who didn’t have the help of community health workers made up a control group. When compared to those receiving intervention services from community health workers, the control group’s Medicaid expenditures proved costly. Meanwhile, researchers found the presence of community health care workers helped save Medicaid more than $1.4 million, yielding a return of $2.47 for every dollar spent.
The authors contended their findings supplement prior research suggesting community health worker interventions improve the health outcomes of individuals, including as it pertains to behavioral health.
Most of the participants in the analysis — 82% — had Medicaid, while the rest were uninsured, one of several limitations of the study identified by authors.
As a result of the researchers’ work, a regional Medicaid payer started reimbursing for social support services, the authors said in the study. They also claim the findings could have relevance for other payers and insurers, as well.
“We have described a community health worker model that achieves a favorable return on investment for Medicaid payers by effectively responding to the social determinants of health,” the authors said in the study.