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extract: 2025-01-01-gimm-hoffman-chw-rct-scoping-review

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domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md
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@ -45,6 +45,12 @@ The claim that budget scoring "systematically" undervalues prevention requires e
The CBO vs. ASPE divergence on Medicare GLP-1 coverage provides concrete evidence: CBO projects $35B in additional spending (2026-2034) using budget scoring methodology, while ASPE projects net savings of $715M over 10 years using clinical economics methodology that includes downstream event avoidance. The $35.7B gap between these estimates demonstrates how budget scoring rules structurally disadvantage preventive interventions. CBO uses conservative uptake assumptions and doesn't fully count avoided hospitalizations and disease progression within the 10-year window, while ASPE includes 38,950 CV events avoided and 6,180 deaths avoided. Both are technically correct but answer different questions—budget impact vs. clinical economics.
### Additional Evidence (challenge)
*Source: [[2025-01-01-gimm-hoffman-chw-rct-scoping-review]] | Added: 2026-03-18*
IMPaCT's $2.47 Medicaid ROI within the same fiscal year demonstrates that at least one category of preventive intervention (CHW programs) generates returns fast enough to be captured within annual budget cycles, not just 10-year windows. This suggests the scoring methodology problem may be less severe for interventions with rapid return profiles.
---
Relevant Notes:

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inbox/archive/.extraction-debug/2025-01-01-gimm-hoffman-chw-rct-scoping-review.json Normal file
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@ -0,0 +1,35 @@
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inbox/archive/2025-01-01-gimm-hoffman-chw-rct-scoping-review.md
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@ -7,10 +7,14 @@ date: 2025-01-01
domain: health
secondary_domains: []
format: paper
status: unprocessed
status: enrichment
priority: high
triage_tag: claim
tags: [community-health-workers, RCT, evidence-review, SDOH, behavioral-health-infrastructure]
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processed_date: 2026-03-18
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---
## Content
@ -43,3 +47,14 @@ Complementary evidence from IMPaCT (Penn Medicine):
## Curator Notes
PRIMARY CONNECTION: SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action
WHY ARCHIVED: Fills the most critical gap in Vida's KB — the evidence for what actually works to change non-clinical health determinants at scale. The 39 RCTs + IMPaCT ROI data provide the strongest evidence base for Belief 2's operational implications.
## Key Facts
- 39 RCTs on CHW interventions in US settings identified between 2000-2023
- 13 of 39 RCTs examined specific health outcomes
- 100% of outcome-focused RCTs showed positive results
- IMPaCT reduced hospital days by 65%
- IMPaCT doubled patient satisfaction with primary care
- IMPaCT generated $1.4M annual Medicaid savings after 12 months
- Most rigorous CHW trials occurred in health care systems and safety-net providers/CHCs
- Limited CHW research exists in public health agencies or insurance organizations