 Since 2009, a programmatic community-based strategy COPE has been implemented to address health disparities among Navajo individuals living with multiple chronic conditions. COPE Community Outreach and Patient Empowerment targets individual, family, and health system-level factors through four activities: 1 coordination between community health representatives CHRs and Indian Health Service providers; 2 CHR competency with standardized training; 3 a culturally-sensitive health promotion curriculum for patients and families; and 4 strong CHR supervision. 