Long-Term Impact of a Postdischarge Community Health Worker Intervention on Health Care Costs in a Safety-Net System

ObjectivePatient navigators (PNs) may represent a cost-effective strategy to improve transitional care and reduce hospital readmissions. We evaluated the impact of a PN intervention on health system costs in the 180days after discharge for high-risk patients in a safety-net system. Data Source/SettingPrimary and secondary data from an academic safety-net health system. Study DesignWe compared per-patient utilization and costs, overall and by age, for high-risk, medical service patients randomized to the PN intervention relative to usual care between October 2011 and April 2013. Intervention patients received hospital visits and telephone outreach from PNs for 30days after every qualifying discharge. Data Collection/Extraction MethodsWe used administrative and electronic encounter data, and a survey of nurses; costs were imputed from the Medicare fee schedule. Principal FindingsTotal costs per patient over the 180days postindex discharge for those aged 60years were significantly lower for PN patients compared to controls ($5,676 vs. $7,640, p=.03); differences for patients aged <60 ($9,942 vs. $9,046, p=.58) or for the entire cohort ($7,092 vs. $7,953, p=.27) were not significant. ConclusionsPatient navigator interventions may be useful strategies for specific groups of patients in safety-net systems to improve transitional care while containing costs.