From the Editor
This issue of the journal is a combination of articles reflecting a newly found abiding interest of ours—community health workers (CHWs). In addition, we highlight a continued focus on practical health care delivery reform particularly as it impacts low-income populations.
The first articles, those on CHWs, come from a number of centers around the country: Adair, Battaglia, Hargreaves, and Pacheco. It is a given, for me, that CHWs are a key member of any health care intervention that is trying to provide coordinated or accountable care. This is especially true for 3 groups of individuals: those laboring under 1 or more disparities, those with multiple comorbid illnesses, or those for whom both are true. So the question is how to pay for these important services. The only possibility I can envision that is financially viable in the long term is that providers receiving a bundled or capitated payment will see it in their financial/clinical interest to hire CHWs. Departments of public health in individual states should ideally jump-start the process. The challenge is that states have no money. Again, as is so often true today, it is a chicken-and-egg challenge. However, the Journal will keep pushing for articles that document the importance of CHWs as our part of encouraging the employment of this key member of the health care team.
The second set of articles by Shi and Ku deal with community health centers (CHCs) and their ever-increasing role in health care delivery reform. Unless CHCs are able to document cost savings, at least in the long term however this is defined, it will be very challenging to continuing supporting them at the current level. While I am confident that this is the case, it is important that we publish articles such as that by Ku. Shi et al. document other aspects of primary health care and CHCs.
We continue our ever-important series of articles from the Republic of Texas.
—Norbert I. Goldfield, MD