Triple Aim Healthcare:
How Does Your Practice Measure Up?
As a society, we do love the idea of things that come in threes. It is usually a sign of good luck, and writers often like to think in terms of threes when creating content. There are Three Pigs, Three Bears and Three Musketeers. Plays often come in three acts. It might have started with Julius Caesar saying, “I came, I saw, I conquered,” but even rock music groups have followed the idea of the rule of three – are you familiar with Blood, Sweat and Tears, for example? And baseball has certainly taken threes to the extreme – with three bases, triples, triple plays, and three strikes.
Considering our fascination for the power of three then, perhaps it is no surprise that when the Institute for Healthcare Improvement, or IHI, put together its approach to optimizing health system performance, it settled on the idea of Triple Aim Healthcare. It is IHI’s belief that medical practices need to develop new designs in order to simultaneously pursue the three goals of achieving effective healthcare, or the “Triple Aim:”
Better Care for the Individual
Improving the individual patient experience by improving quality of care and satisfaction with the level of care provided.
Improved Population Health
By improving quality of care to the individual, it should follow that society as a whole will benefit.
Lower Per Capita Costs
Improving patient results and decreasing the need for chronic care management by improving systems and procedures should result in a decreased cost of providing care. Practitioners should therefore be able to experience increased revenue through more cost-efficient practice and revenue management.
Triple Aim Healthcare is an outgrowth of the IHI’s response to the ever-increasing costs of providing and receiving healthcare in the United States. This may be due to the aging “Baby Boomer” population, increased number of patients with chronic health problems, outdated office records management, lack of efficient communication systems between healthcare providers, or other contributing factors.
To integrate Triple Aim Healthcare into a practice philosophy, IHI recommends following a systematic change process which includes:
- Identify target populations.
- Define system aims and measures.
- Develop a portfolio of project work that is sufficiently strong to move system-level results.
- Conduct rapid testing and implementation, carefully adapted to local community conditions.
The end goal is to empower patients while broadening the impact of primary care, thereby creating a positive health journey throughout the course of a patient’s life.
Achieving the Triple Aim
Implementing the principles of Triple Aim is crucial to healthcare organizations which are making changes in compliance with the move toward a value-based payment system. According to IHI, the initial components involved in concept design for meeting the triple aims include:
1. Provide Patient-Centered Care
- Establish partnerships among individuals, families and caregivers.
- Jointly plan and customize care at the level of the individual.
- Actively learn from the patient and family to inform work for the population.
- Enable individuals and families to better manage their own health.
2. Redesign Primary Care Services and Structures
- Have a team for basic services that can deliver at least 70% of the necessary medical and health-related social services to the population.
- Deliberately build an access platform for maximum flexibility to provide customized health care for the needs of patients, families, and providers.
- Promote interoperability by cooperating and coordinating with other specialties, hospitals, and community health services.
3. Improve Population Health Management
- Work with the community to advocate and provide incentives for healthy eating, smoking prevention, exercise, and reduction of substance abuse.
- Develop multi-sector partnerships, utilize key stakeholder resources (worksites, schools, etc.) and align policies to provide community-based support for all who wish to make health-related behavioral change.
- Understand, engage, measure and improve patient population health care and risk stratification demands.
4. Implement Cost Control Measures
- Achieve a yearly inflation rate of less than 3% for per capita cost by developing cooperative relationships with physician groups and other health care organizations committed to reducing the waste of health care resources.
- Reward health care providers for their contribution to producing better health for the population, and not just producing more health care.
- Orient care over time – the “patient journey” – targeted to the best feasible outcomes.
5. Achieve Total System Integration
- Match capacity and demand for health care and social services across suppliers.
- Ensure that strategic planning and execution with all suppliers including hospitals and other practices are informed by the needs of the population.
- Develop a system for ongoing learning and improvement.
- Institute a sustainable governance and financial structure for the Triple Aim system.
- Efficiently customize services based on appropriate segmentation of the population.
- Use predictive models and health risk assessments that take into account situational factors, medical history, and prior resource utilization to deploy resources to high-risk individuals.
- Set and execute strategic initiatives related to reducing inequitable variation in outcomes or undesirable variation in clinical practice.
Pathways to Population Health
An initiative from IHI and partner organizations, Pathways to Population Health, helps health care change agents make practical, meaningful, and sustainable advances in population health. Their Pathways Framework helps chart paths which can be taken to foment changes in population health. Their work has codified six foundational concepts for Pathways to Population Health:
- Health and well-being develop over a lifetime.
- Social determinants drive health and well-being outcomes throughout the life course.
- Place is a determinant of health, well-being, and equity.
- The health system can respond to the key demographic shifts of our time.
- The health system can embrace innovative financial models and deploy existing assets for greater value.
- Health creation requires partnership because health care only holds a part of the puzzle.
While they encourage practices to celebrate where they are on the population health journey, they also urge them to continue to seek actions which can take population health improvement efforts to an even higher level.
How Does Your Practice Measure Up?
In order to determine how well your practice measures up to the goals of Triple Aim, the IHI suggests asking yourself the following questions:
- Do you currently focus activities on the needs of populations, and improving population results in health, care, and cost? Are you taking responsibility (designing services) for a group of individuals over time to achieve Triple Aim results?
- Is Triple Aim an explicit and understood part of your practice growth strategy?
- Do you measure results around all three dimensions of Triple Aim: population health, care experience, and per capita cost?
- Can results be measured in terms that are SMART: Specific, Measurable, Actionable, Relevant, and Time-Based?
- Are you achieving results in line with expectations?
- Do you have Practice Management Solutions in planning or implementation phases to help achieve Triple Aim goals?
- Is there visibility in communicating your successful outcome improvements to the entire organization in order to encourage team support and engagement?
How Does the EHR Help Achieve Triple Aim Healthcare Goals?
The adaptation of Electronic Health Records, or EHRs, can help medical practices that are seeking to implement Triple Aim Healthcare. An EHR can be used for:
Faster charting with less clicks leaves more time for patient engagement and better access to key patient information during the office interaction. This helps to increase the level of patient satisfaction. Not having to constantly go back and constantly re-enter the same patient data enables the practitioner to develop better care plans with patients and families.
Better scheduling ensures maximum office efficiency, which lends itself to the goal of lower per capita costs. It also ensures that individual patients keep up on yearly appointments and lab testing by providing for quick and easy scheduling reminders.
To work towards the aim of improving population health, practitioners need to be able to spot healthcare gaps within the patient population so they can develop and implement appropriate remediation efforts.
Open Communication Channels
Perhaps one of the most important elements of achieving better patient care is the ability to foster a better flow of communication through the use of a sophisticated patient portal. This can help the practice to electronically exchange messages or share visit summaries, test results and educational materials. It also increases interaction levels before and after office visits, which helps promote the ability to learn from patients and their families
Achieving better internal communications through improved messaging systems helps to increase office efficiencies and lower costs.
One efficient way to lower costs is to improve the billing system so that claims are quickly and efficiently input to insurance providers, and are routinely paid upon a first-time submission.
Triple Aim incorporates elements which focus on mechanisms that provide support for individual patients as well as their family, redesign of primary care services and structures, improved population health management, cost control management, and total system integration. No matter what area of health or health care improvement your practice is in, achieving these components will provide benefits not just in terms of having happier and healthier patients, but also being operated in a more cost-effective and profitable manner.
The IHI has many educational resources, information, and case studies to help your practice conduct a self-assessment, understand what is involved in taking the Triple Aim journey, and collect data to assess your practice in relation to Triple Aim elements. Review the IHI materials carefully to determine whether implementing Triple Aim Healthcare can help your medical practice to be more effective, efficient and profitable.