The caveat: Joint replacements might be a sweet spot for bundled payments. They might not work as well for other episodes of care.
Community health workers liaise between underserved populations and clinicians, help patients and resources to manage disease, and provide health education, informal counseling, and social support. Interest in community health workers is shifting away from narrowly focused intervention on a single disease toward care coordination of multiple chronic conditions.
The caveats: Most of the evidence involves routine care. It is uncertain whether nurse practitioners will be willing to work in rural areas to fill the primary care void.
The caveats: They may need to be part of larger programs to be effective. And smoking rates have fallen but remain stubbornly high among people without privilege.