Return on Investment (ROI)

The Business Case for Community Health Workers


Links to all presentations can be found at:


As a result of (reading these presentations), the (reader) will be able to:

  • Describe who Community Health Workers are and what they do.
  • Understand how CHWs make an impact on health outcomes.
  • Explain two examples in which CHWs have contributed to costs savings for their employers.
  • Identify two strategies on how to integrate CHWs into the workplace, in the context of health reform.
  • Identify 3 sustainable payment models that can be used for Community Health Workers


The Business Case for CHWs: Employers & the ACA New Haven, CT December 11, 2014  

Carl H. Rush, MRP, University of Texas School of Public Health and Joanne L. Calista, MS, LICSW, Central Massachusetts AHEC

Community Health Workers and the Affordable Care Act: Recommended Advanced Payment Models for Employment within Healthcare Reform Programs (23 slides)


  • Enhanced fee-for-advice
  • Value-based Payment (management fee, shared savings)
  • Shared Savings Plan (SSP)
  • Bundled payment (episode of care: disease category)
  • Global Payment (total care, capitation payment: general payment)



ROI Return on Investment Almost 6:1

The Affordable Care Act’s Prevention and Public Health Fund 
The Affordable Care Act, the health care law of 2010, created a Prevention and Public Health Fund. The fund is an unprecedented investment in promoting wellness, preventing disease, and protecting against public health emergencies.

Much of this work is done in partnership with states and communities, which are already using Prevention Fund dollars to help control the obesity epidemic, fight health disparities, detect and quickly respond to health threats, reduce tobacco use, train the nation’s public health workforce, modernize vaccine systems, prevent the spread of HIV/AIDS, increase public health programs’ effectiveness and efficiency, and improve access to behavioral health services.

Preventing Chronic Disease: A Smart Investment

Chronic diseases – such as heart disease, cancer, stroke, and diabetes – are responsible for 7 out of 10 deaths among Americans each year. They account for 75% of the nation’s health spending. Focusing on prevention can both improve the health of Americans and help control health care spending. In fact, a report from Trust for America’s Health entitled Prevention for a Healthier America concluded that investing $1 in proven community-based programs could yield a return of $5.60. ( ROI almost 6:1)

Health Prevention: Cost-effective Services in Recent Peer-Reviewed Health Care 

What GAO Found

GAO reported on preventive health services that were found to be cost-effective and/or cost saving in meta-analyses or comparative studies published in peer-reviewed journals from January 2007 to April 2014. GAO categorized each service identified in the review into a preventive health type (e.g., clinical intervention, screening, or vaccination), and provided information on the target population, whether a service was cost saving, and whether a service had been recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices.

Why GAO Did This Study

Cost-effective preventive health services, such as immunizations and screening, may assist providers in helping patients avoid the onset or worsening of various health conditions. Services are determined to be cost-effective when they improve the benefit (e.g., health outcomes) in a less costly way than a given alternative. Some preventive services may also result in cost savings where the cost of implementing the service is less than the expected future costs to treat a disease or condition. GAO previously reported on available information about the cost-effectiveness of and cost savings from preventive health services in December 2012. GAO found that multiple factors affect these estimates, including the population targeted for a health benefit (e.g., children and high-risk populations) and assumptions about effectiveness of the service (e.g., how many years of protection a vaccine provides). Given the lack of readily available detailed information on the value of preventive services, GAO was asked for additional information on the services that may be potentially cost-effective or cost saving. In this report GAO examined recent peer-reviewed literature to identify preventive services that were shown to be cost-effective and the extent of potential cost savings of these services. GAO conducted a literature review of articles about U.S. preventive services in meta-analyses or comparative studies in peer-reviewed journals published between January 2007 and April 2014 that addressed cost-effectiveness or cost savings. A total of 29 articles met GAO’s inclusion criteria.

What GAO Recommends

GAO is not making any recommendations.

For more information, contact James Cosgrove at 202-512-7114 or