Provider Experience, Community Health Workers, and the Quintuple Aim

 
The Practice Transformation Institute (PTI) Community Health Worker (CHW) educational programs are designed to strengthen CHW knowledge, performance, and measurable impact. CHWs have gained national and state attention to improve healthcare delivery and outcomes.    
PTI’s CHW program teaches nationally recognized C3 Council competencies and prepares participants to function effectively across community and health care settings. 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. This structured training supports CHWs in advancing all elements of the Quintuple Aim. 

Provider Experience and the Quintuple Aim
The Quintuple Aim, developed by the Institute for Healthcare Improvement (IHI, 2025), includes five essential goals for health system performance: population health, patient experience, cost, health equity, and provider experience.  Among these, provider well-being has emerged as a critical factor to reduce burnout and healthcare workforce strain. Improving provider experience is essential to achieving the Quintuple aim and delivering optimal care.

Why Provider Experience Matters
Health care providers (physicians and others) face increasing demands: complex patient care, administrative requirements, workforce shortages, and pressures to achieve productivity.  These challenges contribute to burnout and decreased job satisfaction.  When provider experience decreases, downstream effects include decreases in quality of care, patient experience, practice staff experience, and decreased job satisfaction. Cost of care increases due to inefficiencies, and population health goals become more difficult to achieve.

Provider Experience and Team-Based Care
One of the most effective strategies to improve physician and provider experience is to implement strong, team-based care. Creating an interactive practice team, with team members delivering care and services at the top of their licenses, certifications, and training, allows providers to focus on clinical decision-making while other team members focus on social determinants/drivers of health (SDOH) and logistical needs. Community Health Workers (CHWs) play an essential role in this model.

The Role of Community Health Workers in Team-Based Care
Throughout this series, we have focused on the role of Community Health Workers (CHWs) and their unique position as members of the communities they serve.  CHWs are uniquely positioned to operationalize health equity within care teams, applying lived experience, focusing on cultural norms, and understanding systemic barriers within communities and systems of care.  CHWs extend the care team across clinical settings and communities, bridging gaps between patients, physicians, and providers by addressing non-clinical factors that influence health. 
CHWs support providers by:

•         Addressing barriers, such as food insecurity, transportation, and housing

•         Reinforcing patient education

•         Coordinating follow-up and outreach with patients and families

•         Improving communication between patients and care teams

CHW support allows providers to work more effectively and efficiently, reducing the burden critical social needs place on clinical care delivery time.
                                             Figure 1: CHW Impact on Physicians and Providers

The Role of Community Health Workers in Reducing Physician and Provider Burnout
Burnout occurs when pressures and job demand exceed available resources.  CHWs contribute to reduced physician and provider burnout by balancing demands within practices to meet patient and family needs.  With CHWs in practices, physicians and providers function at the top of their training, care is proactive, and outcomes improve.

This shift reduces burnout and builds a sustainable workforce.

CHW Impact on the Quintuple Aim
CHWs contribute to improvements in every component of the Quintuple Aim.  In addition to improving physician and provider experience, CHW support allows physicians to deliver more consistent, high-quality care, improving population health.  Patient experience improves when providers spend more time with them, fostering patient and physician/provider relationships.  Finally, team-based care including CHWs reduces duplication of services and leads to reduced cost of care.

For more information on PTI CHW education and training, visit https://transformcoach.org/learning-solutions/community-health-worker-chw-program/.  
  
References

• Agency for Healthcare Research and Quality (2025). National Healthcare Quality and Disparities Reports.
• Centers for Disease Control and Prevention (2024).  Retrieved from https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/about/?CDC_AAref_Val=https://www.cdc.gov/nchhstp/healthequity/index.html. 
• Institute for Healthcare Improvement. (2025). The Quintuple Aim.
• Paulson, C.A., Durazo, E.M., Purry, L.D., Covington, A.E., Peters, R.A., Bob, B.A.,  Torchia, S., Beard, B., McDermott, L.E., Lerner, A., Smart-Sanchez, J., Ashok, M., Ejuwa, J., and Cosgrove, S. (2021).  Adding a seat at the table: A case study of the provider’s perspective on integrating community health workers at provider practices in California.  Public Health, 9:690067. doi: 10.3389/fpubh.2021.690067
• Practice Transformation Institute (2025). Community Health Worker Training Program.

 

Equity, Community Health Workers, and the Quintuple Aim

 

The Institute for Healthcare Improvement (IHI, 2025) developed the Quintuple Aim as a framework to improve health system performance. Originally introduced as the Triple Aim in 2012, the framework emphasized improving population health, enhancing patient experience, and reducing per capita cost. The Triple Aim has since evolved to the Quintuple Aim with five interdependent dimensions: population health, patient experience, cost, provider well-being, and health equity.  Health equity is not an “add-on” to the Quintuple Aim.  It is the foundation that determines whether improvements in the other four domains are meaningful and sustainable. This month, we focus on equity and the Community Health Worker role.

 

What Does “Equity” Mean in the Quintuple Aim?

 

Health equity is the attainment of the highest level of health for all people (Centers for Disease Control and Prevention, 2024).  Health equity means that everyone has a fair and just opportunity to attain their highest level of health. Achieving equity requires us to value everyone equally, adjust resources for disadvantaged groups, and remove systemic barriers such as poverty, racism, discrimination, language barriers, geographic isolation, and other social and structural factors.  This concept moves beyond disparities and aims to create an even playing field for all populations. 

 

                        Figure 1.  Advancing the Quintuple Aim (Matheny, et. al)

 

 

The Agency for Healthcare Research and Quality (AHRQ, 2025) examines and documents persistent health disparities on an ongoing basis.  As we reviewed in our cost discussion, the United States experiences significant disparities in maternal health, chronic condition outcomes, and access to care.  These disparities persist, despite spending more per capita on health care than any other developed nation (Organisation for Economic Co-operation and Development, OECD, 2025).  Health equity requires system transformation and a population health (rather than individual or sub-population) focus.

 

Equity and Social Determinants/Drivers of Health (SDOH)

 

Health inequities are rooted in upstream social and structural factors, often referred to as Social Drivers/Determinants of Health (SDOH): 

• Housing stability
• Food security
• Transportation access
• Education and health literacy
• Employment and income
• Access to culturally responsive primary care

 

When these upstream drivers are unmet, individuals are more likely to delay care and use emergency departments for non-emergent needs, resulting in fragmented care.  These patterns are the result of structural inequities and result in adverse health outcomes.

 

Moving to an upstream care model is essential to achieve equity.  The Chronic Care Model (Wagner, 1998) emphasizes proactive, coordinated, community-linked systems.  However, without explicitly focusing on equity and justness (the concept of being fair in action or treatment), upstream efforts may fail to reach communities and populations experiencing the highest levels of structural inequity. 

 

The Role of Community Health Workers in Advancing Equity

 

Throughout this series, we have focused on the role of Community Health Workers (CHWs) and their unique position as members of the communities they serve.  CHWs are uniquely positioned to operationalize health equity within care teams, applying lived experience, focusing on cultural norms, and understanding systemic barriers within communities and systems of care.

 

CHWs advance equity by:

• Identifying and addressing SDOH barriers that disproportionately affect marginalized populations
• Providing culturally and linguistically appropriate education
• Using evidence-based techniques such as motivational interviewing and teach-back to improve understanding and engagement
• Building trust in communities historically at odds with health systems
• Supporting navigation of complex systems such as Medicare, specialty referrals, and social services

 

By addressing root causes rather than symptoms alone, CHWs help ensure that improvement efforts reach populations most affected by inequities.

 

Equity and Physician/Provider Well-Being

 

Equity is also directly tied to physician and provider well-being. When health systems lack adequate infrastructure to address patients’ social determinants/drivers, physicians/clinicians may experience burnout.  Integrating CHWs into care teams takes advantage of the most appropriate team roles, physicians and team members practice at top of license, and patients’ and caregivers’ non-clinical barriers are addressed.  This creates an equity-centered practice model and supports workforce sustainability consistent with the Quintuple Aim.

 

Equity and CHW Investment

 

Investing in CHWs is a strategic way to improve effective, integrated, equity-focused care.  CHWs contribute to: 

• Reduced disparities in preventive service utilization
• Improved chronic care management in targeted, high-risk populations
• Improved prenatal care and postpartum follow-up
• Improved patient and family experience among marginalized populations

 

The Practice Transformation Institute (PTI) CHW educational programs are designed to strengthen CHW knowledge, performance, and measurable impact. PTI is an approved provider of CHW training by the Michigan Department of Health & Human Services (MDHHS) and holds IACET accreditation, reflecting a commitment to training excellence.

 

PTI’s CHW program teaches the nationally recognized C3 Council competencies and prepares participants to function effectively across community and health care settings. This structured training supports CHWs in advancing equity while simultaneously improving outcomes, cost performance, and care coordination.

 

Advancing the Quintuple Aim Through Equity

 

Equity is not separate from cost, quality, or experience; it determines them. Systems that ignore inequities may temporarily improve performance on certain metrics, but disparities will persist or widen. Sustainable transformation requires embedding equity into workforce design, care coordination, community partnerships and value-based models.

 

Investing in equity has the highest potential to achieve the full intent of the Quintiple Aim.  Community Health Workers are central to this transformation and effort to deliver just, equitable care.

References

 

Agency for Healthcare Research and Quality (2025). National Healthcare Quality and Disparities Reports.

 

Centers for Disease Control and Prevention (2024).  Retrieved from https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/about/?CDC_AAref_Val=https://www.cdc.gov/nchhstp/healthequity/index.html. 

 

Institute for Healthcare Improvement. (2025). The Quintuple Aim.

 

Johns Hopkins University (2022).  The difference between health equity and equality.  Retrieved from https://www.hopkinsacg.org/health-equity-equality-and-disparities/.

 

Matheny, M., Israni, S.T., & Whicher, D. (Editors, 2019).  Artificial intelligence in health care:  The hope, the hype, the promise, and the peril. NAM Special Publication. Washington, DC: National Academy of Medicine. 

Organisation for Economic Co-operation and Development (2025). The OECD: Better policies for better lives.

 

Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1, 2–4.

 

Practice Transformation Institute (2025). Community Health Worker Training Program.

 

Cost, Community Health Workers, and the Quintuple Aim

 

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.

 

January is Social Determinants/Drivers of Health (SDOH) Month!

Social determinants/drivers of health (SDOH) are conditions in the environments where people are born, live, learn, work, play, worship and age.  These fall under broad categories: Health Care Access and Quality, Neighborhood and Built Environment, Social and Community Context, Economic Stability, and Education Access and Quality. 

Examples of SDOH include safe housing, access to nutritious foods and physical activity, education, jobs, transportation, language and literacy skills, education, jobs, and physical safety.  Although often non-clinical, these conditions have a major impact on health, well-being, and quality of life.

Addressing SDOH is a priority for the U.S. Department of Health and Human Services to improve the health and well-being of people in the United States (Healthy People 2030).

Community health workers (CHWs) are non-clinical members of care teams uniquely positioned to address SDOH needs.  CHWs have lived experience, cultural humility, and deep knowledge of the communities they serve.  They interact with patients and families to address SDOH, making crucial contributions to improved health.

Please join the Practice Transformation Institute (PTI) in recognizing CHWs and their ongoing commitment to patients, families, and care teams.    

For more information on CHWs and PTI programs, visit the website: https://transformcoach.org/learning-solutions/community-health-worker-chw-program/

Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved 1-7-2026 from https://health.gov/healthypeople/objectives-and-data/social-determinants-health