Implementing a community health worker model to address health-related social needs in a community pharmacy network: A pragmatic evaluation

Background: Health-related social needs (HRSNs) significantly impact health outcomes, and community pharmacies present an opportunity to integrate HRSN screening and referral services. Embedding community health workers (CHWs) within pharmacies may enhance patient engagement and referral uptake, but evidence on program sustainability and economic viability remains limited. Objective: To evaluate key implementation outcomes from statewide implementation of a pharmacy-based HRSN screening and referral program that cross-trained pharmacy staff as CHWs. Methods: A pragmatic evaluation was conducted in 15 community pharmacies in New York State between January and December 2023. Pharmacy staff were cross-trained as CHWs to screen patients using a validated SDoH tool and facilitate referrals through a structured navigation platform. The primary outcome was referral uptake, defined as the proportion of submitted referrals successfully resolved. Secondary outcomes included program fidelity, program reach across urban and rural areas, and economic sustainability assessed using a time-driven activity-based costing framework, implementation framework, and comprehensive cost-benefit analysis. Results: Among the 1034 participants screened, 708 social needs were identified, with food insecurity (24%), housing instability (16%), and transportation barriers (14%) most prevalent. Of the 330 initiated referrals, 154 (47%) were successfully resolved with 64% of screenings conducted in rural regions. The total program cost was $107,107, with estimated annual cost savings of $745,101 yielding a benefit-cost ratio of 6.96 and a return on investment of 596%. Breakeven analysis indicated financial sustainability at varying levels of screening volume, depending on reimbursement rates. Financial viability remained robust under a range of cost and resolution rate assumptions. Conclusion: Cross-training CHWs within pharmacies to address HRSNs is effective and financially sustainable. The program successfully engaged participants across urban and rural areas and resulted in high referral resolution rates. Integrating HRSN programs into pharmacy workflow represents a viable and scalable approach given appropriate policy support and reimbursement mechanisms.