Cost Effectiveness of a CHW-led Prevention Program

In 2008, CPC Community Health created a statewide Community Health Worker (CHW)-based cardiovascular disease prevention program called Colorado Heart Healthy Solutions (CHHS).  The program uses CHWs and Health Navigators (HNs) who perform health screenings that include measuring blood pressure, weight, height, and point-of-service cholesterol and diabetes screenings. This information, combined with targeted CVD health history, access to care, diet and physical activity behaviors, is input into a central data collection and decision support software called the Outreach Screening and Referral (OSCAR) system. CHWs then use OSCAR to generate 10-year CVD risk scores and provide cues for appropriate healthcare referrals and health coaching, incorporating national guidelines based upon participants’ risk factors.

In 2016, CPC Community Health, in collaboration with students and faculty at the Colorado School of Public Health, performed a cost effectiveness analysis of CHHS.  The purpose of this analysis was to determine if CHHS was a good return on investment (ROI) for past and future funders.  Using a theory called a Markov model, CHHS participants were predicted to transition into various states of health; normal health, acute myocardial infarction (MI), post-MI, stroke (ischemic and hemorrhagic), poststroke, congestive heart failure, and death. Cost effectiveness of the program was determined comparing program costs against costs associated with the various states of health previously mentioned.  The most dramatic cost savings were seen in participants at-risk for heart disease of CHHS, with males at-risk for heart disease seeing an incremental cost savings of $5,697 and a ROI of 14.96.  A more dramatic result was seen in female participants at-risk for heart disease seeing an incremental cost savings of $10,478 and a ROI of 27.51.  Overall, CHHS was determined to be a very cost- effective intervention and a good investment.  This study demonstrates that using CHWs/HNs in chronic disease prevention can save money for health insurance companies, state Medicaid and Medicare plans and individual patients.  If you are interested in learning more about the program, contact chhs@cpcmed.org.