ROI research: Community health workers are an unsung bargain

U.S. healthcare gets plenty of bang for its buck out of community health workers, according to a systematic review of the relevant published research. 

In the study, Muhammed Rashid, PhD, MPharm, of the University of Utah and colleagues report finding that interventions by these workers—called CHWs for short—consistently showed high ROI and substantial net cost savings across studies. 

There is a caveat. The profession is not standardized enough to apply uniform performance indicators across its full swath of the healthcare workforce. 

Or, as the authors put it in a paper slated for publication in the June edition of The Lancet Regional Health: Americas, “significant methodological and contextual heterogeneities at CHW, system, analysis and implementation levels influence key outcomes and limit generalizability.”

Having acknowledged the inherent limitation, the researchers flesh out the many positives CHWs contribute to U.S. healthcare—not least their impressive albeit multifarious ROI. 

A 112% rate of return  

For the project, Rashid and co-researchers analyzed some 35 studies representing 41 distinct CHW program across 23 states. 

They found the median inflation-adjusted annual program cost was $155,275, yielding median annual savings of $403,298. 

The median ROI was $2.12 per dollar invested. 

That’s a 112% return. 

Rashid and co-authors suggest the rate is noteworthy given the consistency with which positive returns of similar heft appear in the literature. 

This persistence, they state, “underscores the financial viability and significant value these programs have in enhancing population health.”

Who are the CHWs in your neighborhood? 

According to the Bureau of Labor Statistics, the CHW workforce was more than 65,000 strong as of 2024. 

Their ranks are expected to swell to 72,500 by 2034 (11% growth rate, much faster than the average job). 

Those who fill the positions

• Earn a median annual salary of $51,030. 
• Only need a high school diploma or its equivalent.  
• Generally learn the job by performing its duties. 
• Are employed fulltime in numerous settings—from hospitals to public health departments to community-based organizations.

To this Rashid and colleagues add that “these frontline public health workers serve as crucial bridges between underserved populations and the healthcare system, providing multifaceted services.”

Typical roles, the authors note, include health education, patient navigation, care coordination and social support for vulnerable individuals and people with chronic health conditions.

The authors write: 

“Widespread positive clinical outcomes include fewer hospital and emergency department visits, improved disease management, enhanced healthcare access and increased preventive screening rates.” 

Funding instability a high hurdle  

Rashid and fellow researchers point out that most prior research into the CHW population focused mainly on health outcomes or cost-effectiveness without consolidating ROI evidence.

By contrast, the present analysis “offers the most comprehensive synthesis of US-based CHW return-on-investment evaluations to date.”

Despite the evidence of positive ROI across the literature, sustainable financing remains a stubborn challenge, Rashid and colleagues point out. A nationalized solution may prove difficult to effectuate, they add, because states continue to have a non-uniform funding approach. 

“Funding instability and lack of consolidated cost data further complicate the ROI assessment across settings, which underscore the real impact,” the researchers write. “Medicaid has emerged as one potential pathway to support CHW reimbursement and improve access to CHW services.”

More: 

‘To enhance the reliability and policy relevance of future evaluations, standardized frameworks identifying common indicators, model inputs and evaluating social return on investment (SROI) should be developed. Such frameworks would support more consistent, transparent assessments, enabling policymakers and research funders to make informed resource allocation and scaling of CHW program scaling decisions.’

The paper is posted in full for free.