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.
