Standardized Healthy Life-Years and Federal Life Valuations Place Modeled Programs on Comparable Ledgers
Putting modeled chronic care, mental health aid, and saved lives into shared budget units.
County budget teams compare funding requests from diabetes clinics, mental health teams, and community health worker programs. Each program tracks different chart measures, from blood sugar lab scores to hospital stays and prevented deaths. Translating those outcomes into shared health and life-value units lets leaders compare programs on parallel ledgers.
Putting county program outcomes into common units shows that an assumed 750-client California Community Health Worker cohort produces ~40 healthy life-years per year (~$4.0M at $100K per QALY), while county prevention saves lives at ~$420,000 each annually (32:1 return) and ~$231,000 each over 13-year cumulative horizons (59:1 return at $13.6M per life).[1] Relying only on lab tests undervalues mental health and social aid, which have no blood test yet bring ~55% (~22 of 40 healthy life-years) of modeled gains.[2] Keeping healthy years and saved-life values on separate ledgers avoids double-counting.[3]
Table 1. Turning Clinic & Public Health Scores into Shared Budget Units
Mapping four health streams across analytic perspectives from clinic chart scores into parallel QALY and federal life-value units.
| Valuation Step |
Stream 1: Care (50%)
Chronic Care Control
|
Stream 2: Care (50%)
Mental & Social Aid
|
Stream 3: Full Cohort
Full 750-Client Panel
|
Stream 4: Prevention
Statewide Death Drop
|
|---|---|---|---|---|
| Assumed Cohort Scope & Valuation Rule (Model Input) | QALYs at $50K/$100K/$150K; assumed 375 chronic care clients/yr | QALYs at $50K/$100K/$150K; assumed 225 mental + 150 social = 375 clients/yr | QALYs at $50K/$100K/$150K; assumed 750-client CHW panel/yr | Federal life value $6.3M / $13.6M / $20.7M; 57-county CA panel$10/cap |
| Natural Clinic Score | HbA1c %, BP mmHg, +25% screening | PHQ-9 mood & Z55-Z65 social codes | -22% ED, -30% IP, -23% Readmit | -2.38 yr / -4.32 cumul. per $10/cap |
| Assumed Base Health Score (0 to 1) | 0.74 to 0.75 chronic base | 0.74 high-need Medi-Cal base | 0.40 hospital stay vs. 0.75 stable | 0.00 death endpoint |
| Yearly Health Gain or Lives Saved* | +0.025 QALY / yr per client | +0.040 (MH) & +0.020 (SDOH) / yr | +0.0275 / yr weighted mean | 941 yr / 1,708 cumul. livesstate $10 |
| Discounted Multi-Year Unit* | 0.0486/client18.21 QALYs/yr | 0.0777 MH / 0.0389 SDOH21.83/yr | 0.0534/client40.04 QALYs/yr | 2.38 yr ($420K)4.32 cumul ($231K) |
| Dollar Value* | $1,821,046 / yr QALY Val. | $2,183,037 / yr QALY Val. | $4,004,083 / yr Total QALY | $13.6M / Life$6.3M-$20.7M |
| Value-to-Cost Ratio* | 2.70 : 1at $100K/QALY | 3.23 : 1at $100K/QALY | 2.85 : 1 QALY2.58:1 HCUP | 32:1 Yr (15-49)59:1 Cumul (27-89) |
Table 1 Notes & * Modeled Estimates
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Table 1 Notes & * Modeled Estimates. Rows marked with * apply published fee rates or trial parameters to observed baseline data. Open the notes below for full formulas and data sources.
Sample & Benchmark Scope. Mapping four health streams across analytic perspectives from clinic chart scores into parallel QALY and federal life-value (Value of a Statistical Life, VSL) units.
Column Scope. Chronic Care Control. Healthcare & Plan. Mental & Social Aid. Healthcare & Plan. Full 750-Client Panel. Healthcare & Societal. Statewide Death Drop. Public Health & Societal.
Two-Ruler Benchmark Summary. Mode A: Two Parallel Scales, Assumed Cohort QALYs (N = 750) and 57-County Population VSL (39.5M), Never Summed. Ruler 1: Daily Health Ruler (Discounted QALYs): 0.0534 QALYs / Client (~$4.0M Cohort). From a 0.74 base health score (0 = dead, 1 = full health), assumed yearly gains (50% chronic at +0.025, 30% mental health at +0.040, 20% social needs at +0.020 = +0.0275/yr) over 2 years (3% discount) yield ~40 QALYs/yr (worth ~$4.0M at $100K/QALY). Ruler 2: Saved-Life Value Ruler (HHS 2025 VSL Tiers): $13.6M Central VSL (32:1 Yr / 59:1 Cumul.). For county deaths (Cholette et al., 2026: -2.38 annual / -4.32 cumulative deaths/100K per $10/person = ~$420,000 / ~$231,000 per life saved), HHS 2025 VSL tiers value each saved life at $6.3M (15:1 / 27:1), $13.6M (32:1 / 59:1), or $20.7M (49:1 / 89:1).
Method & Data Audit (TooEarlyToSay.com): Statewide CHW Reimbursement Analysis →
Table 2. Shared Unit Rules, Double-Count Limits & Policy Fit
How analysts avoid double-counting and match the unit to the budget choice.
| Decision Choice | Chronic Care Control | Mental & Social Aid | Full 750-Client Panel | Statewide Death Drop |
|---|---|---|---|---|
| Where the Return Shows Up | Patients gain daily chronic-care health while health plans capture lower clinic bills. | Clients gain mental health and social stability across non-lab care pathways. | Patients gain 40 healthy life-years while hospitals and plans save bed days. | Communities gain prevented premature deaths valued on the federal VSL ledger. |
| Why Shared Units Aid Budget Choices | Lets clinics compare a 0.5% HbA1c drop against asthma or blood pressure care. | Mental health aid (+0.040/yr) brings 43.7% of cohort QALYs despite no lab test. | Places daily health gains (~40 QALYs/yr) beside avoided hospital bed days. | Turns death drops (-2.38 yr / -4.32 cumul per 100K) into dollar returns ($32 to $59 per $1). |
| Double-Counting Limit | Give one primary health weight per client instead of adding two illness weights. | Keep caseload shares separate. | Do not count hospital bill savings in both the top and bottom of a cost ratio. | Apply the $13.6M VSL only to saved lives, never to daily QALY gains. |
| Score Range & Sensitivity | Varying the assumed chronic weight from +0.015 to +0.035 shifts QALYs by ±40%. | Health gains last 2.0 years in the base run (1.0 to 3.0 years in range checks). | Hospital stays cut the health score from 0.75 to 0.40 (-0.35 acute drop). | Federal life values span $6.3M (15:1 yr / 27:1 cumul), $13.6M (32:1 / 59:1), and $20.7M (49:1 / 89:1). |
| Recommended Policy Use | Clinic & Health Plan Quality Teams. Use chronic QALYs to support CPT 98960 staffing. | CalAIM & Mental Health Programs. Use mental (+0.040/yr) and social (+0.020/yr) weights for G0019/G0022 aid. | Hospital & Health System Leaders. Show cohort QALY value (~$4.0M/yr) beside HCUP bed savings (~$2.9M/yr). | County Boards & State Lawmakers. Use HHS VSL tiers to support base budgets. |
Table 2 Notes: Weighted QALY Math & HHS 2025 VSL Tiers
Expand notes
• Weighted QALY Math (Mode A Scenario Assumptions): Across an assumed 750-client cohort, the three illustrative cohort streams yield 18.21 QALYs per year (375 chronic care clients at +0.025/yr), 17.49 QALYs per year (225 mental health clients at +0.040/yr), and 4.34 QALYs per year (150 social needs clients at +0.020/yr). Discounted over 2 years at 3.0% per year (factor 1.9417 on a +0.0275 yearly lift), this gives 0.0534 QALYs per client, or 40.0404252 QALYs per year (40.04 rounded) across 750 clients.
• HHS 2025 VSL & LHA Death Math (Mode B): At 2.38 fewer deaths per 100,000 per $10 spent annually (-0.238 per $1), the cost per saved life is $10 / (2.38 / 100,000) = $420,168, giving return ratios of 15.0:1 [15:1] ($6.3M Low), 32.4:1 [32:1] ($13.6M Central), and 49.3:1 [49:1] ($20.7M High). Over the 13-year cumulative horizon (-4.32 per 100,000 per $10), cost per life saved is $231,481, yielding 27.2:1 [27:1] Low, 58.8:1 [59:1] Central, and 89.4:1 [89:1] High.
• Extended Cell Context. Double-Counting Limit (Mental & Social Aid). Keep caseload shares separate (50% chronic, 30% mental, 20% social = 100%). · Recommended Policy Use (Chronic Care Control). Use chronic QALYs (+0.025/yr, ~$4,900 value) to support CPT 98960 staffing. · Recommended Policy Use (Statewide Death Drop). Use HHS VSL tiers ($6.3M to $20.7M, 15:1 to 89:1) to support base budgets.
How Shared Units Keep Upstream Care from Being Priced at Zero
In county health budgets, services with direct billing codes or lab blood tests easily win funding because their outputs are simple to count. Meanwhile, mental health aid, social-needs outreach, and countywide disease tracking face an uphill case. Without a shared unit, a budget office has no clear way to weigh a 20-person depression outreach team against a diabetes clinic or an environmental health unit.
Turning daily health gains into QALYs and saved lives into HHS Value of a Statistical Life (VSL) tiers levels the playing field across analytic perspectives. It shows that mental health and social outreach bring more than half (~55%, or ~22 of 40 QALYs/yr) of an assumed CHW cohort's total quality-of-life gain. At the same time, countywide public health spending saves lives at ~$420,000 each annually and ~$231,000 over cumulative horizons, returning $15 to $89 in social value per $1 spent.
Data Sources, Model Inputs, Notes & Endnotes
(Numbered endnotes [1]–[6], state data sources & math rules)
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Case Study Focus: Resource Funding & Economic Value · QALYs & VSL Valuation (Mode A Standardization)
Numbered Endnotes & Main Sources
- [1]Healthy Life-Year Gains (QALYs): Second Panel on Cost-Effectiveness in Health and Medicine. We use a 3% yearly discount rate across an assumed 750-client California county cohort under DHCS SPA 22-0001. A weighted health lift of +0.0275 per year over 2 years gives 0.0534 QALYs per client. That totals 40.04 QALYs per year, worth $4.00M at $100K per QALY.
- [2]Caseload Share Split (Mode A Scenario Assumptions): Each client gets one main weight in this illustrative cohort scenario: 50% chronic care (+0.025/yr = 18.21 QALYs/yr), 30% mental health (+0.040/yr = 17.49 QALYs/yr), and 20% social needs (+0.020/yr = 4.34 QALYs/yr).
- [3]Federal Life Value Tiers (HHS 2025 VSL): U.S. HHS ASPE 2025 VSL Schedule. Values are $6.3M Low (15:1 annual / 27:1 cumulative return), $13.6M Central (32:1 annual / 59:1 cumulative return), and $20.7M High (49:1 annual / 89:1 cumulative return) at $420,168 annual and $231,481 cumulative per life saved.
- [4]U.S. EPA Mortality Risk Valuation ($11.2M VSL)
- [5]California DHCS SPA 22-0001
- [6]Cholette et al., 2026
Mode Classification (Mode B Federal Schedules & LHA Slopes + Mode A Cohort QALY Scenario): HHS 2025 VSL tiers ($6.3M / $13.6M / $20.7M), U.S. value benchmarks ($50K / $100K / $150K per QALY), and the CAPHE LHA death slopes (-2.38 annual and -4.32 cumulative per 100K per $10 spent) are Mode B facts. Cohort QALY parameters (+0.025/yr chronic, +0.040/yr mental health, +0.020/yr social needs across a 50%/30%/20% split at $1,800/client ongoing cost) and totals (40.04 QALYs/yr across 750 clients, or 0.0534 QALYs/client over 2 years at 3% discounting) are illustrative Mode A scenario assumptions.
Primary References & Data Sources: See U.S. Department of Health and Human Services (HHS) ASPE Guidelines for Regulatory Impact Analysis (2025 VSL Schedule) and U.S. EPA Mortality Risk Valuation ($11.2M VSL). We also use the Second Panel on Cost-Effectiveness in Health and Medicine (3% discount standard) and California DHCS SPA 22-0001.
Companion Method & Code Guides (TooEarlyToSay.com)
- Why Flat Medi-Cal Rates Underfund Community Health Care. Across 58 California counties and 9,039 census tracts, a flat $31.74 Medi-Cal fee schedule covers 3.2% to 8.9% of modeled field community health worker costs.
Common Questions & Method Notes
- What is a Quality-Adjusted Life Year (QALY) and how is it calculated?
- A QALY combines length of life and daily health quality into one unit, where 1.00 is one year in full health and 0.00 is death. If an outreach team lifts a client's health score from 0.74 to 0.7675 (+0.0275 per year) for 2 years, it produces 0.0534 discounted QALYs at a 3% yearly discount rate.
- When should analysts use QALYs ($50K-$150K/QALY) versus the Value of a Statistical Life ($13.6M VSL)?
- QALYs and value benchmarks ($50K/$100K/$150K per QALY) are used in Cost-Effectiveness Analysis (CEA) to value daily health gains in care cohorts. VSL ($6.3M Low, $13.6M Central, $20.7M High) is used in Cost-Benefit Analysis (CBA) strictly to value prevented deaths across a population.
- How do we avoid double-counting when a client has both diabetes and depression?
- Instead of adding two separate illness weights for the same person, assign one primary weight per client (50% chronic care at +0.025, 30% mental health at +0.040, 20% social needs at +0.020). Analysts can also use a single multi-symptom survey like the EQ-5D.