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      Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment

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          Abstract

          Interventions that address socioeconomic determinants of health are receiving considerable attention from policy makers and health care executives. The interest is fueled in part by expected returns on investment. However, many current estimates of returns on investment are likely overestimated, because they are based on pre-post study designs that are susceptible to regression to the mean. We present a return-on-investment analysis that is based on a randomized controlled trial of Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention that addresses unmet social needs for disadvantaged people. We found that every dollar invested in the intervention would return $2.47 to an average Medicaid payer within the fiscal year.

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          Accountable Health Communities--Addressing Social Needs through Medicare and Medicaid.

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            Social conditions as fundamental causes of disease.

            Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. We question the emphasis on such individually-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effect in the time ahead. There are two reasons for this claim. First we argue that individually-based risk factors must be contextualized, by examining what puts people at risk of risks, if we are to craft effective interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change. Without careful attention to these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunities to adopt broad-based societal interventions that could produce substantial health benefits for our citizens.
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              A Systematic Review of Interventions on Patients’ Social and Economic Needs

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                Author and article information

                Contributors
                Role: associate professor
                Role: professor
                Role: associate professor
                Role: professor
                Role: professor
                Journal
                8303128
                4064
                Health Aff (Millwood)
                Health Aff (Millwood)
                Health affairs (Project Hope)
                0278-2715
                1544-5208
                26 October 2021
                February 2020
                03 November 2021
                : 39
                : 2
                : 207-213
                Affiliations
                Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
                Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania.
                Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.
                Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.
                Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.
                Author notes
                Article
                NIHMS1748829
                10.1377/hlthaff.2019.00981
                8564553
                32011942
                4101a1f8-727e-479b-9872-3e3e17f5ea41

                This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/.

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