Journal of Community Health

, Volume 38, Issue 6, pp 1050–1057 | Cite as

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

  • Alberta M. Mirambeau
  • Guijing Wang
  • Laural Ruggles
  • Diane O. Dunet
Original Paper

Abstract

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.

Keywords

Community health worker Program cost Health care system 

Notes

Acknowledgments

The authors thank the members of the NVRH Community Connections team, all of whom made invaluable contributions to the data collection process used in this study: Pamela Smart, Stephen Kline, Constance S. Sandahl, and Shauna Barrett. The authors also thank Dr. Nell Brownstein for her subject matter expertise in the development of this paper. This study was funded by CDC Task Order No: 0020 for Contract No. 200-2008-27957.

References

  1. 1.
    Centers for Disease Control and Prevention. (2011). Rising health care costs are unsustainable. Retrieved from http://www.cdc.gov/workplacehealthpromotion/businesscase/reasons/rising.html.
  2. 2.
    Fedder, D. O., Chang, R. J., Curry, S., et al. (2003). The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Ethnicity and Disease, 12(1), 22–27.Google Scholar
  3. 3.
    Johnson, D., Saavedra, P., Sun, E., et al. (2012). Community health workers and Medicaid managed care in New Mexico. Journal of Community Health, 37(3), 563–571.CrossRefPubMedGoogle Scholar
  4. 4.
    Felix, H. C., Mays, G. P., Stewart, M. K., et al. (2011). The care span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Affairs, 30(7), 1366–1374.CrossRefPubMedGoogle Scholar
  5. 5.
    Viswanathan, M., Kraschnewski, J. L., Nishikawa, B., et al. (2010). Outcomes and costs of community health worker interventions: A systematic review. Medical Care, 48(9), 792–808.CrossRefPubMedGoogle Scholar
  6. 6.
    Health Resources and Services Administration, Office of Rural Health Policy. (2011). Community health workers evidence-based models toolbox. Washington, DC: US Department of Health and Human Services, HRSA. Retrieved from http://www.hrsa.gov/ruralhealth/pdf/chwtoolkit.pdf.
  7. 7.
    Wolff, N., Helminiak, T., Morse, G., et al. (1997). Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients. American Journal of Psychiatry, 154(3), 341–348.PubMedGoogle Scholar
  8. 8.
    Smedley, B., Stith, A., & Nebon, A. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine.Google Scholar
  9. 9.
    Primomo, J., Johnston, S., DiBiase, F., et al. (2006). Evaluation of a community-based outreach worker program for children with asthma. Public Health Nursing, 23(3), 234–241.CrossRefPubMedGoogle Scholar
  10. 10.
    Elder, J. P., Ayala, G. X., Campbell, N. R., et al. (2005). Interpersonal and print nutrition communication for a Spanish-dominant Latino population: Secretos de la Buena Vida. Health Psychology, 24(1), 49–57.CrossRefPubMedGoogle Scholar
  11. 11.
    Patient Protection and Affordable Care Act (2010). Public Law No. 111–148, §2702, 124 Stat. 119, 318–319. Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf.
  12. 12.
    Paskett, E. D., Harrop, J. P., & Wells, K. J. (2011). Patient navigation: An update on the state of the science. Cancer Journal for Clinicians, 61(4), 237–249.CrossRefGoogle Scholar
  13. 13.
    Varner, A., & Murph, P. (2010) Cancer patient navigation: Where do we go from here? Oncology Issues, pp. 50–53. http://accc-cancer.org/oncology_issues/articles/mayjune10/MJ10-VarnerMurph.pdf.
  14. 14.
    Stockdale, S. E., Keeler, E., Duan, N., et al. (2000). Costs and cost-effectiveness of a church-based intervention to promote mammography screening. Health Services Research, 35(5 Pt 1), 1037–1057.PubMedGoogle Scholar
  15. 15.
    Institute of Medicine. (2012). Living well with chronic illness: a call for public health action. Washington, DC: National Academy of Sciences. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2012/Living-Well-with-Chronic-Illness/livingwell_chronicillness_reportbrief.pdf.
  16. 16.
    Harrison, P. L., Pope, J. E., Coberley, C. R., et al. (2012). Evaluation of the relationship between individual well-being and future health care utilization and cost. Population Health Management, 15(6), 325–330.CrossRefPubMedGoogle Scholar
  17. 17.
    Saatci, E., Tahmiscioglu, G., Bozdemir, N., et al. (2010). The well-being and treatment satisfaction of diabetic patients in primary care. Health Quality of Life Outcomes, 8, 67.CrossRefPubMedGoogle Scholar
  18. 18.
    Allen, J. K., Himmelfarb, C. R., Szanton, S. L., et al. (2011). COACH trial: A randomized controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers: Rationale and design. Contemporary Clinical Trials, 32(3), 403–411.CrossRefPubMedGoogle Scholar
  19. 19.
    Rural Assistance Center. (2012). Vermont. Retrieved from http://www.raconline.org/states/vermont.php.
  20. 20.
    US Census Bureau. (2012). Vermont state and county quickfacts. Retrieved from http://quickfacts.census.gov/qfd/states/50000.html.
  21. 21.
    US Census Bureau. (2012). Caledonia County, Vermont state and county quickfacts. Retrieved from http://quickfacts.census.gov/qfd/states/50/50005.html.
  22. 22.
    Vermont Department of Health. (2012). Behavioral risk factory surveillance system data map. Retrieved from http://healthvermont.gov/research/IA/HSA/SingleMap/atlas.html.
  23. 23.
  24. 24.
    Centers for Disease Control and Prevention. (2012). Interactive atlas of heart disease and stroke. Retrieved from http://apps.nccd.cdc.gov/DHDSPAtlas/viewer.aspx?state=VT.
  25. 25.
    Walker, D. G., & Jan, S. (2005). How do we determine whether community health workers are cost-effective? Some core methodological issues. Journal of Community Health, 30(3), 221–229.CrossRefPubMedGoogle Scholar
  26. 26.
  27. 27.
    Krieger, J. W., Takaro, T. K., Song, L., et al. (2005). The Seattle-King County Healthy Homes Project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4), 652–659.CrossRefPubMedGoogle Scholar
  28. 28.
    Whitley, E. M., Everhart, R. M., & Wright, R. A. (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor Underserved, 17(1 Suppl), 6–15.PubMedGoogle Scholar
  29. 29.
    Balcazar, H., Alvarado, M., Hollen, M. L., et al. (2006). Salud para Su Corazon-NCLR: A comprehensive promotora outreach program to promote heart-healthy behaviors among Hispanics. Health Promotion Practice, 7(1), 68–77.CrossRefPubMedGoogle Scholar
  30. 30.
    Brown, H. S., Wilson, K. J., Pagan, J. A., et al. (2012). Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes. Preventing Chronic Disease, 9, 120074.CrossRefGoogle Scholar
  31. 31.
    Brownstein, J. N., Bone, L. R., Dennison, C. R., et al. (2005). Community health workers as interventionists in the prevention and control of heart disease and stroke. American Journal of Preventive Medicine, 29(5S1), 128–133.CrossRefPubMedGoogle Scholar
  32. 32.
    Wang, G., Macera, C. A., Scudder-Soucie, B., et al. (2004). Cost analysis of the built environment: The case of bike and pedestrian trials in Lincoln, Neb. American Journal of Public Health, 94, 549–553.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2013

Authors and Affiliations

  • Alberta M. Mirambeau
    • 1
  • Guijing Wang
    • 1
  • Laural Ruggles
    • 2
  • Diane O. Dunet
    • 1
  1. 1.Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Northeastern Vermont Regional HospitalSt. JohnsburyUSA

Personalised recommendations