Community Health Workers Lead to Better Health in Low-Income Patients

As politicians struggle to solve the nation's health care problems, a new study finds a way to improve health and lower costs among Medicaid and uninsured patients.

Researchers at the Perelman School of Medicine at the University of Pennsylvania showed that patients who received support from community health workers (CHWs)—trained local residents who provide tailored support to high-risk patients—had 30% fewer hospital admissions in one year compared with those who didn't receive CHW support. The results, published in the American Journal of Public Health, also showed reductions in cigarette smoking, obesity, diabetes severity, and mental illness. This is the second clinical trial to demonstrate improved health and hospital reductions with the IMPaCT (Individualized Management for Patient-Centered Targets) CHW program. The annual return on investment for the program was $2 for every dollar invested.

The IMPaCT program pairs CHWs with chronically ill patients from low-income neighborhoods. CHWs meet with patients regularly to encourage more healthful behaviors and otherwise provide support for the patients' own health goals.

Emblematic of the kind of patients who benefit from CHW interventions, one young woman who was unemployed, struggled with low self-esteem and had tried for years to lose weight before she met CHW Saphia Allen. Allen helped the patient find affordable interview clothes and went with her to job fairs. Allen also connected the patient to other neighborhood women and twice each week attended get-togethers with the group where the women would take walks together and share their real-life challenges. With her newfound community, the patient lost 10 lbs and gained employment.

In the new study, the Penn team focused on 302 mostly Medicaid-insured individuals who had multiple chronic diseases. One-half received regular support from IMPaCT-trained CHWs. After six months, the patients who had received support from CHWs showed better outcomes on several measures, including lower blood sugar levels, lower BMI, and reduced cigarette smoking. Patients in the intervention group also showed improvements in mental health and were 20% more likely to rate their primary care as comprehensive and supportive of their disease self-management."This is the second clinical trial that shows improved health and lower hospital admissions for the IMPaCT community health worker program," says senior author Shreya Kangovi, MD, an assistant professor of medicine at the Perelman School of Medicine and executive director of the Penn Center for Community Health Workers. In 2014, Kangovi and colleagues found evidence that the IMPaCT model improved mental health and lowered hospital readmission among patients recently discharged from the hospital. "We now have evidence for state Medicaid programs or health systems looking for proven strategies to improve health and lower hospital use."

Based on the reduction in hospitalizations seen in the studies, the University of Pennsylvania Health System estimates a return on investment of $2 for every $1 spent on IMPaCT.

"As a nation, we have spent years arguing about health care. We need to focus on getting people healthy while reducing spending," says Ralph Muller, CEO of the University of Pennsylvania Health System. "This program accomplishes both of these goals and shows us a way forward."

— Source: Perelman School of Medicine at the University of Pennsylvania