Recently, there is a tremendous amount of focus on the value of social interventions and healthcare costs. To be of optimal help to the greater society, it is important for us to thoroughly understand how to investigate the value of such interventions.
In the journal, Health Affairs, a recent study by Kangovi et al. investigates the return on investment for an evidenced-based community health worker program that addresses unmet social needs. Their study asserts a possible return of $2.47 for every dollar invested in a Medicaid population across one year.
This finding is without a doubt intriguing, but what is of greater importance is the results of the conversation concerning how to best address such questions. First, the study points to the importance of identifying interventions that show the effectiveness, and not the extrapolation that other models will deliver similar results. Furthermore, their study involves a design that includes a combined theory and action-based approached, along with required hands-on support. This finding is critical as it focuses on personal activation and engagement while simultaneously delivering identified needed support. This approach is also very different from many other situations, which focus much more on the approach of “screen-and-refer,” thus missing the engagement component.
Next, they address the necessity for a study design that identifies the financial value that is more encompassing than just those that are predicted to be high cost. Thus, they incorporate multiple metrics to identify the correct population to intervene. And third, it is imperative to address the financial returns to those that are funding the intervention. This is a major issue when we tend to look at an intervention that has long-term implications but defines the ROI for a much shorter period. This need is due to how we finance healthcare and the fact that the long-term beneficiary is not always the institution that provides the investment.
Finally, we tend to ignore the true social return because of the issue mentioned above. Thus, we underestimate the overall ROI to creating a healthier society. One could argue if we included this factor, then regardless of who pays for the intervention, as long as we all do it, all investors would benefit over time.
As we mature into our present models, we must also expand our thinking on how to define success and the value of our interventions. Not only is it imperative to study whether a model is effective, but it also behooves us to understand how to study the true financial impact, both for the investor and the entire ecosystem. A value-chain component to our thinking must be included in our model designs and our defining success. We have limited resources; hence great diligence is required for us to understand how to best invest. Only through a scientific approach will we be able to identify what works and what does not. Thus, we must adjust our study methodologies to encompass a different model of intervention.