Who gets the savings with community health workers?

So, who gets the savings? Let's assume that community health workers are successful, as Michael "Chris" Gibbons says they were in Baltimore, in reducing the number of babies who end up in the neonatal intensive care unit. All good, right? Maybe.

All good for everyone except doctors who specialize in that kind of care. 

"The issue of saving money is a complicated one," said Gibbons, associate director of the John Hopkins Urban Health Institute. "The question becomes savings to whom?" 

"Babies who go into neonatal intensive care unit are extremely expensive babies to care for," he said in a conversation we had while I was researching my Inquirer article on community health workers.  "Each one of these babies that goes in there costs $55,000 in their first few weeks and that doesn’t include the costs that come after that. These babies become extremely expensive, because Medicaid is not reimbursing the hospital at $55,000."

Gibbons says community health workers saved the hospital "$2 million, just from babies that we averted. But the doctors don’t see a dime of that money."

This issue reminds me of a similar one faced by employers with "wellness" plans. Let's say an employer installs a gym, stocks the cafeteria with fruit and even goes so far as to set up an in-office medical clinic. It's a big investment, which could well pay off in lower insurance premiums if employees stick around. But in today's mercurial workforce, stability isn't a given. Why should an employer pay to get an employee well so his next employer doesn't have to pay for as many sick days?

That's the problem. It's fine to talk globally about how things can change, how health can be improved, how costs can be lowered in the health system overall. But in order to get buy-in, the benefit has to be immediate and financially obvious to each participant. We think globally, we react locally -- as locally as the wallet in our own pocket.  

Read my Inquirer story from Sept. 27 about community health workers.

• Thursday: Down in the Delta: Community health workers and the rural poor 

• Friday: Domestic abuse: Should community health workers intervene?

• Monday: Protecting the heart: Community health worker burnout

• Tuesday: Flavor of the month funding for community health workers

• Today: Who gets the savings for community health workers

• Thursday: Temple's big ambition: Setting a standard for community health workers