Health Care Access Now: Calculating the ROI of a Care Coordination Program to Address Social Determinants of Health

Douglas McCarthy
Victor Tabbush
Case Example
March 2020

The Return-on-Investment (ROI) Calculator for Partnerships to Address the Social Determinants of Health, developed by The Commonwealth Fund, is designed to support successful financial partnerships between community-based organizations (CBOs) and health care organizations. This case study illustrates how Health Care Access Now (HCAN), a Cincinnati-based CBO, used the ROI Calculator to support discussions with potential health care organization partners. HCAN, which offers care coordination services delivered by community health workers for high-need individuals, analyzed historic data that demonstrated an average patient cost reduction of $667 per month after completion of the program.

HCAN used the ROI Calculator to project the ROI and model various case rates that could offer protection from financial risk along with an attractive value proposition for a health care organization. HCAN used the ROI Calculator outputs and models of various payment types, such as fee-for-service, case rate, and capitation, to inform discussions with potential funding partners.

Ultimately, as health care organizations refer more patients to CBOs for nonmedical services, new financial arrangements can help ensure that social services organizations have the necessary capacity to meet this increased need. The ROI Calculator offers a potential tool to help CBOs and health plans develop mutually beneficial financial arrangements. CBOs may mitigate contracting challenges by accounting for competition, understanding federal and state regulatory requirements for Medicaid health plans, and marshalling strong evidence.

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