Medicaid Savings Resulted When Community Health Workers Matched Those With Needs To Home And Community Care

Felix, Holly C.; Mays, Glen P.; Stewart, M. Kathryn; Cottoms, Naomi; Olson, Mary K.

doi:10.1377/hlthaff.2011.0150

Cited by 66 publications

(51 citation statements)

References 25 publications

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“…41,[43][44][45][46] Three cohort studies assessed the effect of the intervention on hospitalizations. One showed a decrease in costs without significance given 52 ; two indicated a significant decrease relative to an observation cohort. 5,49 Urgent Care Visits…”

Section: Emergency Department Visitsmentioning

confidence: 91%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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BACKGROUND: As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS: Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION: Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

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Section: Emergency Department Visitsmentioning

confidence: 91%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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“…As health care costs continue to rise, so does the need to contain costs by delivering health care services with greater efficiency. One way to do this is to make full use of health care extenders, such as community health workers (CHWs), who have been shown to help reduce healthcare costs [2–4]. …”

Section: Introductionmentioning

confidence: 99%

“…The authors found a substantial reduction in the number of claims and payments for emergency room care, inpatient services, prescription drugs, and outpatient primary and specialty care. In another study involving Medicaid patients, specially trained CHWs in the Arkansas Community Connectors program identified patients at risk for nursing home care and linked them to home and community-based resources [4]. The authors reported a 23.8 % average reduction in annual Medicaid spending per participant over a 3-year period [4].…”

Section: Introductionmentioning

confidence: 99%

A Cost Analysis of a Community Health Worker Program in Rural Vermont

et al. 2013

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Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews. We analyzed personnel and operational costs from October 2010 to September 2011. The estimated total program cost was $420,348, a figure comprised of $281,063 (67 %) for personnel and $139,285 (33 %) for operations. CHW salaries and office space were the major cost components. Our cost analysis approach may be adapted by others to conduct cost analyses of their CHW program. Our cost estimates can help inform future economic studies of CHW programs and resource allocation decisions.

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“…Although proving the cost effects of a particular state's proposed cuts would entail case-specific factual development, plaintiffs in Olmstead litigation regularly present such evidence. Some empirical research (Wiener et al 2017;Felix et al 2011) and statistical modeling (Kaye 2012) suggest that providing community-based services as part of Medicaid may save states money on a program-wide, and not simply individual, level. When the question is whether the ADA requires maintenance of an existing level of HCBS, rather than the adoption of new avenues for covering HCBS, concerns about a potential "woodwork effect" are less pertinent.…”

Section: How Strong a Bulwark Is Olmstead Against Retrenchment Of Hommentioning

confidence: 99%

Community Integration of People with Disabilities: Can Olmstead Protect Against Retrenchment?

Crossley

2017

Laws

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Abstract:Since the passage of the Americans with Disabilities Act (ADA) in 1990, states have made significant progress in enabling Americans with disabilities to live in their communities, rather than institutions. That progress reflects the combined effect of the Supreme Court's holding in Olmstead v. L.C. ex rel. Zimring, that states' failure to provide services to disabled persons in the community may violate the ADA, and amendments to Medicaid that permit states to devote funding to home and community-based services (HCBS). This article considers whether Olmstead and its progeny could act as a check on a potential retrenchment of states' support for HCBS in the event that states face severe reductions in federal funding for Medicaid, as was threatened by Republican efforts in 2017 to "repeal and replace" the Affordable Care Act and to restructure Medicaid. The article concludes that Olmstead provides a strong basis for challenging a state's elimination or severe curtailment of existing HCBS programs, but that the fact-specific nature of a state's likely "fundamental alteration" defense precludes predicting the outcome of such a challenge. Despite this legal uncertainty, protests mounted by people with disabilities, in which they demanded freedom from institutionalization, may have helped cement the idea that community integration is a civil right in the public's mind.

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Medicaid Savings Resulted When Community Health Workers Matched Those With Needs To Home And Community Care

Cited by 66 publications

References 25 publications

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

A Cost Analysis of a Community Health Worker Program in Rural Vermont

Community Integration of People with Disabilities: Can Olmstead Protect Against Retrenchment?

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