Taking Innovation to Scale: Community Health Workers, Promotores, and the Triple Aim

The US health care system has entered an era that will require nothing short of a fundamental transformation in the way that care is delivered. Expanded enrollment of uninsured populations and movement towards global budgeting will create incentives for increased investment in new models of primary care and population health interventions to reduce the demand for high cost specialty and inpatient care. There is growing acknowledgement of the need to adopt a broader perspective on what kinds of services, where services are delivered, and who is most appropriate to provide different types of services. This evolution in thinking is leading inexorably to the recognition that we must look beyond traditional services in order to address the social and environmental conditions that perpetuate and exacerbate poor health in our communities.

Community health workers and promotores (CHWs) have been engaged for decades by many of our community health clinics to serve as bridges between traditional service models and community-based prevention. The time has come to more strategically engage these important members of primary care teams and to bring them into the mainstream of the US health care system.

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