The
Quintuple Aim is a framework developed by the Institute for Healthcare
Improvement (IHI, 2025) to understand and improve health system performance.
Originally proposed as the Triple Aim in 2012, the framework focused on
improving population health, enhancing patient experience, and reducing health
care costs. Over time, the model expanded to include other human and equity
dimensions of care, resulting in the Quintuple Aim: population health, patient
experience, cost, provider well-being, and health equity.
In
prior discussions, we explored population health and patient experience,
highlighting the essential role Community Health Workers (CHWs) play in
delivering high-quality, team-based care. This month, we will discuss cost,
which is often considered the most challenging aspect of the Quintuple Aim.
What does “cost” mean in the Quintuple Aim?
In
the context of the Triple Aim, cost refers to the total cost of care for
a population. While total cost
of care (TCOC) includes the price of services, it is broader and more
complex. TCOC includes avoidable
emergency department use, inpatient admissions and readmissions, duplication of
services (such as tests and medications), inappropriate utilization, and waste
caused by inefficiencies.
Increased
health care costs place financial strain on patients, families, employers/purchasers,
payers, and government programs (e.g., Medicare and Medicaid). The Organisation for Economic Co-operation
and Development (OECD) is a group of 37 economically developed member countries
that shape policies that foster prosperity, equality, opportunity, and
well-being for all (OECD, 2025). The United
States has the highest health care cost per capita of all OECD countries. However, this increased spending does not
consistently improve outcomes. For example, certain important U.S. health
outcomes (life expectancy, maternal mortality, and hospitalizations for heart
failure and diabetes) also exceed all OECD countries (Peterson KFF Health
Systems Tracker, 2025).
Consistent
with the Quintuple Aim and the Chronic Care Model (Wagner, 1998), achieving
health care value (decreasing cost while simultaneously improving quality
outcomes) will depend on shifting from reactive care to proactive, coordinated,
community-based approaches that address utilization drivers.
Cost and Social Determinates/drivers of Health (SDOH)
A
significant portion of health care spending is driven by Social
Determinants/drivers of Health (SDOH). We
often refer to “upstream” and “downstream” care. Downstream care occurs after a problem is
identified by treating symptoms and managing associated complications. Upstream care focuses on prevention, root
causes, and addressing conditions before illnesses or problems occur. When
individuals have unmet SDOH needs (e.g., food insecurity, unstable housing,
transportation barriers, lack of access to primary care) they are more likely
to delay care and experience worsening chronic conditions. This cycle often
results in high-cost services, such as emergency department visits and
inpatient admissions where care remains downstream. Moving care upstream will require us to understand
how social and environmental factors influence downstream utilization and to invest
in strategies to prevent avoidable costs before they occur.
The role of Community Health Workers (CHWs) in cost reduction
Community
Health Workers (CHWs) play a critical role in advancing the cost dimension of
the Quintuple Aim. As we have discussed, CHWs are trusted members of the
communities they serve and bridge gaps between clinical care and everyday life.
Their lived experience and cultural responsiveness, including using the
patient’s primary language, enable CHWs to identify SDOH needs and other barriers
to support patients and health teams. The
figure below estimates the percentages of TCOC components and potential CHW
impact:
CHWs help reduce costs by:
- Educating patients on self-management using evidence-base “teach-back,” “show-back,” and motivational interviewing techniques to increase preventive care utilization and reduce inpatient admissions
-
Improving
follow-up after emergency department visits, redirecting patients to primary
care and potentially preventing future inappropriate ED use
-
Connecting
patients to community-based resources that address SDOH
By addressing root causes rather than symptoms alone, CHWs help shift
care upstream, improving outcomes while lowering unnecessary utilization and TCOC.
Investing in CHWs as a cost containment strategy
Increasing
evidence shows that CHWs are not an added expense but a high-value investment.
When integrated effectively into care teams, CHWs contribute to lower
utilization, improved quality outcomes, and improved patient and provider
experience, advancing multiple dimensions of the Quintuple Aim.
The
Practice Transformation Institute (PTI) CHW educational programs are designed
to strengthen CHW knowledge, performance, and impact. PTI is an approved
provider of Community Health Worker training by the Michigan Department of
Health & Human Services (MDHHS), following a rigorous approval process and
years of community and health system partnership. PTI is also uniquely
distinguished by its IACET accreditation, underscoring its commitment to
training excellence.
PTI’s
CHW program teaches the nationally recognized C3 Council competencies and
equips participants with the skills needed to function effectively across a
variety of community and health care settings. This robust training supports
CHWs in contributing meaningfully to cost reduction, improved outcomes, and
sustainable system transformation.
Investing in prevention, care coordination, and community-based solutions can improve outcomes while managing costs more effectively. CHWs are central to this effort, helping align clinical care with SDOH and other patient needs to advance the Quintuple Aim in practice.
References
Agency
for Healthcare Research and Quality (2025).
National healthcare quality and disparities reports. Refer to reference in figure.
Institute
for Healthcare Improvement. (2025). The Quintuple Aim.
Organisation
for Economic Co-operation and Development (2025). The OECD: Better policies for better
lives. Retrieved from https://www.oecd.org/en/about.html
Peterson
KFF Health Systems Tracker (2025). How
does the quality of the U.S. health system compare to other countries? Retrieved from
https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/
Wagner,
E. H. (1998). Chronic disease management: What will it take to improve care for
chronic illness? Effective Clinical Practice, 1, 2–4.
