Community health workers save lives — they may save health care
A relatively small force of community social workers played a significant role in preventing 165,000 premature deaths across the U.S. in 2015. Our recently concluded research indicates that they did this by guiding at-risk men and women to preventive treatments and early detection of common killers, such as colon cancer and diabetes.
Let's set aside, for a moment, the moral victory represented by each life saved and look at what this means from the standpoint of exploding medical costs and health-care policy. Although some find the idea repugnant, you actually can put a dollar value on a human life.
If we accept the most conservative estimate of $3.3 million, the efforts of community health workers in 2015 were worth $545 billion to the U.S. economy. To put that in perspective, the healthcare legislation that stalled in Congress last month promised savings of $321 billion to $420 billion, primarily by reducing care for millions of Americans.
The potential savings emerged as we assessed how efficiently each U.S. state uses its available resources to prevent death from diseases that can be avoided by simple lifestyle changes or are easily detected at an early, treatable stage.
Wyoming ranked highest in efficiency. Oklahoma was lowest. Our findings indicate that the greater use of community health-care workers, augmented by other efficiencies common in top-performing states, could potentially reduce the nation's health-care bill by $1.2 trillion a year while improving the quality of care.
An above-average reliance on health workers was the most prominent marker shared by the 10 most efficient states. They employ, on average, 51 percent more community workers per capita than the 10 worst performers.
The most efficient states share other common characteristics that lower costs. They average 22-percent fewer uninsured residents, and their Medicare costs are 50-percent lower than the worst performers.
Our research to date only goes deep enough to identify these markers. Further study is needed to explain how the top-ranked states use community health workers and what the rest of the country can learn from their example.
We don’t yet know why more people in these states have private health insurance or why Medicare costs are lower. Without more information, we can’t be absolutely certain that emulating the top performers will produce the same outcomes elsewhere.
Can a densely populated, multi-ethnic state such as California or New York match Wyoming's efficiency solely by hiring more health-care workers? At the very least, programs in California and New York probably would require modifications to address the variations in language and culture that health workers would encounter.
What we can say with confidence is that these characteristics are distinguishing elements of efficient, lower-cost health-care systems. Providers, policymakers and advocates at the state and federal levels should examine them and look for ways to adopt them on a wider basis.
Of course, no single step will solve America's health-care crisis, but one or two small steps in the right direction may help put U.S. health care on the right path.
Too often, we have allowed partisanship to frame the health-care debate as a zero-sum game pitting the economy against compassion: to control costs we must cut services or, conversely, the fortunate must pay more so the less fortunate can receive care.
This approach stifles reasonable discussion and has allowed the U.S. to fall far behind its economic peers. We need a new perspective. To insist that higher quality is impossible without higher cost requires the illogical conviction that health care, unlike every other human endeavor, is immune to efficiency and innovation. It is not.
This article originally appeared in The Hill on October 19, 2017.