One fall morning in Harlem, Marisilis Tejeda sat herself down on the couch in the fifth-floor apartment of Ramon Jimenez, a 62-year-old Guatemalan immigrant who has had heart disease for 20 years.

It had been just over a month since his most recent hospitalization, and Tejeda, a community health worker, goes over his medicine list, making sure he’s taking his pills correctly and consistently. She checks that he’s properly limiting, and monitoring, sodium and fluids, essential for a patient with congestive heart failure. She reviews the warning signs that he must watch for to spot another brewing crisis and makes sure he knows who to call at the cardiology clinic if he notes sudden weight gain or shortness of breath.

They banter. “How did you sleep?” she asks. “Alone,” Jimenez replies, with exaggerated sorrow and a big wink.

Tejeda’s visit is an example of an approach that’s beginning to catch on in modern American health care, that of pushing care outward from expensive hospital settings and into people’s homes, keeping diseases in check and preventing patients from cycling in and out of the emergency room. It’s precisely in line with the latest thinking about our medical system: a cost-effective jolt of primary care that prioritizes communication and teaches patients to keep themselves as well as they can for as long as they can.

But this idea wasn’t built by consultants or a fancy medical school. It was borrowed from India and Africa…..more