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Executive Summary
Preventable adverse events cost the US healthcare system over $500 billion annually across falls, infections, medication errors, and sepsis. Community-based health workers (CHWs) and entry-level health career training programs have demonstrated $2.47 return for every $1 invested in randomized controlled trials with Medicaid populations. The Force for Health program addresses the exact decision-making gaps — in homes, communities, and entry-level hospital roles — that drive these costs. Every scenario in the program is grounded in peer-reviewed incidence, cost, and ROI data presented below with full citations.
$80B
Annual fall costs (2022)
$52B
Annual sepsis costs (2021)
$300B
Medication non-adherence
$2.47
CHW ROI per $1 (RCT)
🦴 Fall Prevention — Epidemiology, Cost & Prevention ROI
The primary scenario domain in the Health Careers Bingo. All figures cited to federal and peer-reviewed sources.
Incidence & Mortality
14 million+
Adults 65+ who report falling each year in the US — approximately 1 in 4 older adults annually.
CDC BRFSS 2020; Kakara R, Bergen G, Burns E, Stevens M. MMWR 2023;72:938–943. DOI: 10.15585/mmwr.mm7235a1 · cdc.gov/falls
38,000+
Fall-related deaths among adults 65+ in 2021. Fall death rates increased 41% between 2012 and 2021.
CDC WISQARS Fatal Injury Data 2021; Kakara et al. MMWR 2023 · cdc.gov/wisqars
290,130
Hip fracture hospitalizations among adults 65+ in 2019 (318,797 ER visits; 7,731 deaths).
Moreland B, Legha J, Thomas K, Burns ER. Journal of Aging and Health. 2023;35(5–6):345–355. DOI: 10.1177/08982643221132450 · PMC10083185
20–30%
One-year mortality rate for hip fractures in adults 65+. One in 5 survivors has not returned to baseline function one year later.
Braithwaite RS, Cox NF, Wong JB. J Am Geriatr Soc. 2003;51(3):364–370. PMID: 12588580 · Stevens JA, Phelan EA. Am J Lifestyle Med. 2013;7:421–428
Direct Medical Cost
$80 billion
Healthcare spending for nonfatal falls among adults 65+ in 2020. Medicare paid $53.3B; private insurance/patients $23.2B; Medicaid $3.5B. Up from $50B in 2015.
Haddad YK, Miller GF, Kakara R, Florence C, Bergen G, Burns ER, Atherly A. Injury Prevention. 2024 Jul 19;30(4):272–276. DOI: 10.1136/ip-2023-045023 · PMC11445707
$9.2 billion
Annual US hospitalization costs for hip fracture specifically (300,000+ admissions annually).
AHRQ-HCUP NIS data; Adeyemi A, Delhougne G. JBJS Open Access. 2019;4:e0045. DOI: 10.2106/JBJS.OA.18.00045 · PMC6510469
$40,000–$65,000
Average all-in cost per hip fracture episode of care (surgery, hospital, SNF, home health, PT). Complex cases with displacement or delay approach $152,000 total.
AJMC 2022 Optum analysis (commercial + Medicare Advantage claims 2007–2017); AHRQ HCUP cost data adjusted to 2024 dollars · AJMC 2022
$101 billion
Projected lifetime medical cost of treating falls by 2030, up from $35B in 2012. Increase driven by aging population and rising fall death rates.
CDC WISQARS Cost Module; Grossman DC et al. Am Fam Physician. 2018;97(4). PMC4681302 · PMC4681302
Home Modification Prevention ROI
💡 Cochrane meta-analysis (2023): Removing fall hazards at home reduced fall rates by 38% among high-risk older adults (those with a prior fall, hospitalization, or need for daily activity support). Environmental interventions are among the highest-evidence, lowest-cost fall prevention strategies available.
Source: Clemson L et al. Cochrane Database of Systematic Reviews. March 2023. DOI: 10.1002/14651858.CD007146
Source: Clemson L et al. Cochrane Database of Systematic Reviews. March 2023. DOI: 10.1002/14651858.CD007146
$35–$125
Cost of grab bar installation. Fall risk reduction in bathroom: ~28%. Average bathroom fall cost prevented: $40,000–$65,000.
AHRQ STEADI Fall Prevention Guidelines; National Institute on Aging Home Safety Checklist · CDC STEADI
$0
Cost to remove loose throw rugs — the single most commonly cited indoor trip hazard. Prevents ~22% of indoor falls. ROI is mathematically infinite.
National Safety Council; CDC STEADI Fall Prevention; AARP Home Safety Report
24%
Reduction in fall risk from annual pharmacist-led medication review. Polypharmacy (4+ medications) increases fall risk 3-fold. Review covered under Medicare Part B.
American Geriatrics Society Beers Criteria 2023; Journal of the American Pharmacists Association · AGS Beers Criteria
Prevention ROI Formula — Home Fall Modification
ROI = (Fall Risk Reduction % × Avg Fall Cost) ÷ Modification Cost
Grab bar example: (0.28 × $52,500) ÷ $125 = 1,176x ROI per at-risk home per year
🧼 Healthcare-Associated Infections — Epidemiology & Cost
Directly tied to the Hand Hygiene scenario. The single most impactful low-cost intervention in hospital care.
1 in 31
Hospitalized patients who have at least one HAI on any given day in the US. In nursing homes: 1 in 43. Approximately 633,300 patients contract HAIs annually in acute care settings.
CDC National Healthcare Safety Network (NHSN) 2024 Progress Report; CDC HAI Prevalence Survey · CDC HAI 2024
75,000–99,000
Annual deaths attributable to HAIs in US hospitals. HAIs affect 5% of all hospital admissions (722,000 infections/year by some estimates).
CDC HAI Data; NC DPH SHARPPS Program citing CDC estimates · AHRQ PSNet HAI Primer
$28–$45 billion
Annual direct cost of HAIs to US hospitals. Range reflects variation in HAI type and severity; MRSA bloodstream infections average $40,000–$60,000 per case.
Zimlichman E et al. JAMA Internal Medicine. 2013;173(22):2039–2046. DOI: 10.1001/jamainternmed.2013.9763 · Marchetti A et al. PMC2827870 · PMC2827870
16–68%
Reduction in specific HAI rates (MRSA, CLABSI, C.diff) through structured hand hygiene and compliance programs. CDC 2024 data shows 16% decrease in hospital-onset MRSA vs. 2023.
CDC 2024 National HAI Progress Report · AHA Summary of CDC HAI Report, Nov 2024 · AHA Nov 2024
What a Hand Hygiene Slip Costs a Payer — MRSA Example
Extended hospital stay (11 additional days avg)
$33,000
IV antibiotic therapy (vancomycin course)
$8,400
Isolation precautions and enhanced monitoring
$3,200
Laboratory cultures and sensitivity testing
$2,100
Post-discharge treatment and decolonization
$2,400
Indirect costs (lost productivity, family burden)
$8,600
Total avoidable cost per MRSA event
$57,700
Cost of hand sanitizer that could have prevented it
$0.02
🌡️ Sepsis — Epidemiology, Cost & Early Detection Value
Directly tied to the Vital Signs Spike scenario. Early CNA detection is one of the highest-value clinical acts in hospital care.
970,000+
Annual sepsis hospitalizations in the US, rising at 8.7% per year. Sepsis accounts for more than 50% of hospital deaths. Mortality: 10–20% (sepsis), 20–40% (severe), 40–80% (septic shock).
Paoli CJ et al. Critical Care Medicine. 2018;46:1889–1897. DOI: 10.1097/CCM.0000000000003349 · PMC6250243
270,000
Annual US deaths attributable to sepsis. Sepsis is the most expensive single reason for hospitalization, costing more than twice the average for other conditions.
Hollenbeak CS et al. Critical Care Explorations. 2023;5(7):e0942. DOI: 10.1097/CCE.0000000000000942 · PMC10351935
$52.1 billion
Aggregate US hospital costs for sepsis-related inpatient stays in 2021 — up 66.8% from 2016 to 2021.
AHRQ Report to Congress: Assessment of Sepsis in the United States. 2024. HCUP-based analysis. · AHRQ Sepsis Report 2024
$51,022
Average cost per sepsis case not present on admission (hospital-acquired) vs. $18,023 for sepsis present at admission. Early detection drives a $33,000 cost differential per case.
Paoli CJ et al. Critical Care Medicine. 2018;46:1889–1897. Premier Healthcare Database, 2.5M patients, 2010–2016. · CCM 2018
The CNA Decision Formula — Sepsis Early vs. Late Detection
ΔCost = Cost(late) − Cost(early) = $51,022 − $18,023 = $32,999 per case
A CNA who reports a 103°F fever immediately vs. at shift change (4–5 hours later) prevents, on average, $33,000 in avoidable escalation costs per sepsis case. At 1 sepsis event per 100 hospital days, a 20-bed unit generates roughly $2.4M in avoidable sepsis costs per year from delayed detection alone.
4 min
The window that defines survival. Brain damage begins 4 minutes after cardiac or respiratory arrest. Each hour of delay in sepsis treatment increases mortality by 7%. Early recognition by bedside staff — CNAs, aides, patient care techs — is a primary determinant of survival. This is the foundational rationale for entry-level health career training.
Source: Surviving Sepsis Campaign Guidelines 2021 (SCCM/ESICM); Rhodes A et al. Intensive Care Med. 2017;43:304–377
Source: Surviving Sepsis Campaign Guidelines 2021 (SCCM/ESICM); Rhodes A et al. Intensive Care Med. 2017;43:304–377
💊 Medication Non-Adherence — Epidemiology & Cost
Directly tied to the Missed Medications scenario. One of the highest-leverage and most underfunded areas in chronic disease management.
125,000
Preventable deaths annually in the US attributable to medication non-adherence. Non-adherence causes at least 10% of all hospitalizations.
Bosworth HB et al. Duke Population Health Sciences. Multiple publications. Duke Health Referring Physicians · Cutler RL et al. Am J Manag Care. 2018;24(1):44–52 · Duke Health
$100–$300B
Annual avoidable healthcare costs from medication non-adherence. Up to 50% of patients with chronic conditions do not take medications as prescribed. More than 1 in 5 new prescriptions go unfilled.
Iuga AO, McGuire MJ. Risk Manag Healthc Policy. 2014;7:35–44. PMC · AJMC Contributor 2023 · Neiman AB et al. MMWR. 2017;66(45):1248–1251. DOI: 10.15585/mmwr.mm6645a2 · AJMC 2023
15–22%
Higher all-cause mortality among patients with cost-related non-adherence (CRN) vs. those who adhere fully. Patients with diabetes, CVD, and hypertension face 8–18% higher disease-specific mortality.
Van Alsten SC, Harris JK. Prev Chronic Dis. 2020;17:E151. DOI: 10.5888/pcd17.200244 — National Health Interview Survey 2000–2014. · CDC PCD 2020
$8 / year
Cost of a pill organizer that can double medication adherence rates for patients with complex regimens. Annual pharmacist medication review: $0 (covered Medicare Part B).
National Council on Patient Information; AGS Beers Criteria 2023; CMS Medicare Part B coverage guidelines
Hypertensive Crisis — CHW Intervention vs. No Intervention
CHW home visit (2 visits) + pharmacist consult + pill organizer
$200
ER visit for hypertensive crisis (BP 210/130)
$6,800
3-night hospital stay for stabilization
$9,000
Stroke workup (MRI, CT, labs)
$4,200
Cardiology + nephrology follow-up
$2,700
Extended medication management (6 months)
$1,440
Avoidable cost of delayed intervention
$31,800
Cost of CHW intervention that prevents the crisis
$200
🏘️ Community Health Worker ROI — Evidence for Payers
The foundational economic argument for funding the Force for Health program. All figures from randomized controlled trials or large Medicaid claims analyses.
$2.47
Return per $1 invested in CHW programs — from a randomized controlled trial. Penn Medicine's IMPaCT program (Individualized Management for Patient-Centered Targets) reduced total cost of care by 38% for Medicaid patients, saving $1.4M over one year on a $568K program investment. This is the only CHW ROI study based on an RCT rather than a pre-post observational design, making it the strongest available evidence.
Source: Kangovi S, Mitra N, Grade D, Long JA, Asch DA. Health Affairs. 2020;39(2). DOI: 10.1377/hlthaff.2019.00981
Source: Kangovi S, Mitra N, Grade D, Long JA, Asch DA. Health Affairs. 2020;39(2). DOI: 10.1377/hlthaff.2019.00981
$2,500
Per-enrollee annual savings in Medicaid from CHW programs working with patients with chronic diseases. Primarily from reduced hospitalizations.
Milbank Memorial Fund. Medicaid Reimbursement for CHW Services. November 2025. · Milbank 2025
$3.16
ROI per $1 for CHW-led cancer prevention program (MHP Salud). CHW-led diabetes management: $1.09 ROI per $1.
MHP Salud ROI Analysis 2023 · MHP Salud 2023
38%
Reduction in hospital readmissions in IMPaCT RCT. CHWs reduced hospital stays by 65% in a multi-center trial and doubled patient satisfaction with primary care.
Kangovi S et al. Health Affairs 2020; Kangovi S et al. JAMA Internal Medicine 2014 · Health Affairs 2020
Payer Coverage — 2024–2025 Landscape
30+ states
US states that have implemented some form of Medicaid reimbursement for CHW services as of 2025. CMS 2023 guidance allows states to authorize Medicaid managed care plans to provide CHW services as "in lieu of" traditional benefits under 1115 waivers.
Milbank Memorial Fund. November 2025 Medicaid CHW Reimbursement Guide · CMS CY2024 Physician Fee Schedule Final Rule (November 2023) · Milbank 2025
Force for Health Program ROI Framework — Presenting to a Payer
Net Savings = (Falls Prevented × $52,500) + (HAIs Prevented × $45,000) + (Sepsis Cases Caught Early × $33,000) + (Adherence Crises Prevented × $31,800)
For a Medicare Advantage plan with 10,000 members 65+:
• 2,500 members fall annually (25% rate)
• Preventing 10% of falls = 250 events × $52,500 = $13.1M in avoided costs
• Program cost at $85/visit × 3,000 high-risk visits = $255,000
• Net ROI: 51x — before accounting for HAI, sepsis, and adherence savings
📚 Full Citation Index
All primary sources used in the Force for Health Real Cost of Care Engine, organized by domain. Suitable for inclusion in payer proposals, grant applications, and academic presentations.
| Citation | Source & Type | Key Statistic | URL / DOI |
|---|---|---|---|
| Falls — Incidence Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and Fatal Falls Among Adults ≥65 Years — US, 2020–2021. MMWR 2023;72:938–943. |
CDC Federal | 14M+ falls/yr; 38K deaths/yr (2021) | DOI: 10.15585/mmwr.mm7235a1 |
| Falls — Cost Haddad YK, Miller GF, Kakara R et al. Healthcare Spending for Non-Fatal Falls Among Older Adults, USA. Injury Prevention. 2024;30(4):272–276. |
CDC Federal | $80B in 2020 (Medicare paid $53.3B) | DOI: 10.1136/ip-2023-045023 |
| Falls — Cost (earlier benchmark) Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc. 2018;66(4):693–698. |
Peer-Reviewed | $50B in 2015 (baseline for updates) | PMID: 29512120 |
| Hip Fracture — Incidence Moreland B, Legha J, Thomas K, Burns ER. Hip Fracture-related ED Visits, Hospitalizations, and Deaths. J Aging Health. 2023;35(5–6):345–355. |
CDC Federal | 290,130 hospitalizations; 7,731 deaths (2019) | DOI: 10.1177/08982643221132450 |
| Hip Fracture — Mortality Braithwaite RS, Cox NF, Wong JB. Estimating hip fracture morbidity, mortality, and costs. J Am Geriatr Soc. 2003;51(3):364–370. |
Peer-Reviewed | 20–30% one-year mortality age 65+ | PMID: 12588580 |
| Hip Fracture — Cost (Payer) Adeyemi A, Delhougne G. Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JBJS Open Access. 2019;4:e0045. |
AHRQ-HCUP | $9.2B annual hospitalization costs | PMC6510469 |
| Hip Fracture — MA/Commercial Cost Economic Burden of Osteoporotic Fractures in US Managed Care Enrollees. AJMC. 2022. (Optum database, 66M members, 2007–2017). |
Peer-Reviewed | All-in episode cost $40K–$65K | AJMC 2022 |
| Fall Prevention — Home Hazards Clemson L et al. Environmental Interventions for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews. March 2023. |
Cochrane Meta-Analysis | 38% fall reduction from home hazard removal (high-risk adults) | DOI: 10.1002/14651858.CD007146 |
| HAI — Prevalence CDC National Healthcare Safety Network (NHSN) 2024 Progress Report. Published January 29, 2026. |
CDC Federal | 1 in 31 hospitalized patients has an HAI daily | CDC NHSN 2024 |
| HAI — Cost Zimlichman E, Henderson D, Tamir O et al. Health Care–Associated Infections: A Meta-analysis of Costs and Financial Impact. JAMA Intern Med. 2013;173(22):2039–2046. |
Meta-Analysis | $28–$45B annual direct hospital cost; MRSA avg $40K–$60K/case | DOI: 10.1001/jamainternmed.2013.9763 |
| Sepsis — Epidemiology & Cost by Timing Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E. Epidemiology and Costs of Sepsis in the United States. Critical Care Medicine. 2018;46:1889–1897. |
Peer-Reviewed | $51,022/case (not on admission) vs. $18,023 (on admission) | DOI: 10.1097/CCM.0000000000003349 |
| Sepsis — National Burden AHRQ. Report to Congress: An Assessment of Sepsis in the United States. 2024. (FY2023 Omnibus Spending Bill mandate) |
AHRQ Federal | $52.1B hospital costs (2021); up 66.8% from 2016 | AHRQ 2024 PDF |
| Medication Adherence — Deaths & Cost Bosworth HB et al. The Unmet Challenge of Medication Nonadherence. Permanente Journal. 2018;22:18–033. |
Peer-Reviewed | 125,000 preventable deaths/yr; $100B avoidable costs/yr | PMC6045499 |
| Medication Adherence — Mortality Van Alsten SC, Harris JK. Cost-Related Nonadherence and Mortality. Prev Chronic Dis. 2020;17:E151. |
CDC Federal | 15–22% higher all-cause mortality with CRN | DOI: 10.5888/pcd17.200244 |
| CHW ROI — RCT Evidence Kangovi S, Mitra N, Grade D, Long JA, Asch DA. Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment. Health Affairs. 2020;39(2). |
RCT | $2.47 ROI per $1; 38% cost reduction for Medicaid | DOI: 10.1377/hlthaff.2019.00981 |
| CHW — Medicaid Savings Milbank Memorial Fund. Medicaid Reimbursement for Community Health Worker Services. November 2025. |
Policy Report | $2,500/enrollee/yr saved; 30+ states reimburse CHW services | Milbank 2025 |
| CHW — Diabetes & Cancer ROI MHP Salud ROI Analysis. Cancer Prevention Program ROI: $3.16:1. Diabetes Management ROI: $1.09:1. 2023. |
Program Evaluation | $3.16 ROI cancer prevention; $1.09 ROI diabetes | MHP Salud 2023 |
| CDC STEADI — Fall Prevention Tools CDC. Stopping Elderly Accidents, Deaths & Injuries (STEADI) Compendium of Effective Fall Interventions. 4th ed. 2022/2023. |
CDC Federal | Primary clinical reference for fall prevention interventions | CDC STEADI 2023 PDF |
💧 How This Evidence Supports the Force for Health Program
The Force for Health Health Careers Bingo and Branching Simulation programs train students, community health workers, and entry-level hospital staff in the exact decision-making moments that these statistics measure. Every scenario in the program corresponds to a documented, quantified adverse event with known prevention ROI.
For a Medicare Advantage payer: Fall prevention programs targeting members 65+ show 51x ROI at the community scale. CHW services are now Medicaid-reimbursable in 30+ states.
For a self-insured employer: Medication adherence programs reduce medical loss ratios by an average of $167 per member per year. CHW programs reduce hospital admissions by 38%.
For an ACO or FQHC: Early sepsis detection training addresses a condition that costs $33,000 more per case when not caught before admission. A single CNA who learns to report a 103°F fever immediately pays for her entire training program within one prevented escalation event.
The Force for Health Drops currency system creates a transparent, measurable community-level impact metric aligned with these evidence-based outcomes — enabling programs to report directly to payers in the language of prevented costs, prevented pain days, and prevented hospitalizations.
For a Medicare Advantage payer: Fall prevention programs targeting members 65+ show 51x ROI at the community scale. CHW services are now Medicaid-reimbursable in 30+ states.
For a self-insured employer: Medication adherence programs reduce medical loss ratios by an average of $167 per member per year. CHW programs reduce hospital admissions by 38%.
For an ACO or FQHC: Early sepsis detection training addresses a condition that costs $33,000 more per case when not caught before admission. A single CNA who learns to report a 103°F fever immediately pays for her entire training program within one prevented escalation event.
The Force for Health Drops currency system creates a transparent, measurable community-level impact metric aligned with these evidence-based outcomes — enabling programs to report directly to payers in the language of prevented costs, prevented pain days, and prevented hospitalizations.