The Triple Aim framework has emerged as a guiding principle for healthcare organizations seeking to optimize patient care outcomes while simultaneously containing costs.
Developed by the Institute for Healthcare Improvement (IHI), the Triple Aim provides a holistic approach to healthcare delivery by focusing on three interrelated goals: improving population health, enhancing patient experience, and reducing healthcare costs.
This article aims to delve into the rationale behind the Triple Aim, its intended objectives, and its profound impact on health systems and medical providers.
The Need for a Transformation
The United States, like many other nations, faces several healthcare challenges, including escalating costs, inconsistent quality of care, and fragmented systems. The existing fee-for-service model has contributed to excessive healthcare spending without necessarily translating into improved patient outcomes. Consequently, the need for a fundamental transformation in healthcare delivery arose, giving rise to the Triple Aim.
The Triple Aim Explained: Improve Population Health
The first aim of the Triple Aim is to improve the overall health of populations. This involves addressing the determinants of health, promoting preventive care, and implementing evidence-based interventions to manage chronic diseases effectively. By focusing on population health, healthcare providers aim to reduce the incidence of preventable diseases and enhance the overall well-being of communities.
Enhance Patient Experience
The second aim of the Triple Aim is to enhance the patient experience of care. This encompasses various aspects, including improving access to care, fostering effective communication between patients and providers, ensuring care coordination, and respecting patients’ preferences and values. Patient-centered care lies at the heart of this aim, striving to create a healthcare system that meets the unique needs and expectations of each individual.
Reduce Healthcare Costs
The third aim of the Triple Aim seeks to reduce healthcare costs without compromising the quality of care. Healthcare systems are encouraged to adopt innovative approaches to resource management, eliminate waste, and streamline processes to achieve financial sustainability. By addressing inefficiencies and focusing on cost-effective care, the Triple Aim aims to make healthcare more affordable and accessible for all.
The joint venture just announced between Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. is anticipated to bring profound transformation to the healthcare industry. By joining forces, these three giants hope to leverage their technological, sales, and investment expertise to address and resolve the many inefficiencies in the current U.S. healthcare system. The objective of this partnership is to harness their considerable scale and operational efficiency to manage healthcare’s rapidly growing costs, placing greater emphasis on providing high-value healthcare services.
Regardless of whether the partners are successful in disrupting the healthcare industry, one positive outcome is the strength these new players bring the comparative weakness of the fragmented American healthcare system into sharp relief. In the press release, Berkshire Hathaway Chairman and CEO Warren Buffett explains the primary motivator of the joint venture with the now-infamous phrase, “The ballooning costs of healthcare act as a hungry tapeworm on the American economy.” With healthcare accounting for 17.9 percent of the gross domestic product in 2016, the “hungry tapeworm” of exploding healthcare costs is fueled by the widespread inefficiencies of the U.S. healthcare system.
The industry is still riding out significant aftershocks from recent M&A activity. In the last month alone, CVS purchased Aetna for $69 billion to remake the consumer healthcare experience, Catholic Health Initiatives (CHI) and Dignity Health joined forces to expand their reach across 28 states with 700 care sites and 139 hospitals, and Providence St. Joseph Health and Ascension are expected to merge to create the largest hospital operator in America. In the statement, Amazon Founder and Chief Executive Jeff Bezos acknowledges, “The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.” With the healthcare industry in the midst of significant upheaval, any new players will face an uphill battle in addressing rising healthcare costs and creating transparency within a notoriously-opaque system.
Addressing the “Tapeworm Effect,” as Buffet mentions, presents a blue ocean for disruptive innovation. The paradigm shift from fee-for-service to value-based care models requires healthcare systems to become increasingly patient-centric. To lower their costs, healthcare systems must eliminate variations and inefficiencies in their care processes that lead to poor patient outcomes, such as hospital-acquired infections and 30-day readmissions. By investing in data-driven technology, healthcare organizations can create systemic improvements in care delivery at every touchpoint across the patient journey.
Guest post by Marie Murphy, managing director of health solutions, CTG.
Marie Murphy
Since the inception of meaningful use in 2011, healthcare organizations have been implementing technology designed to help protect and improve the quality, safety, and efficiency of patient data. Three years after the launch of meaningful use, organizations that claimed to reach Stage 2 were given patient portal requirements to help achieve the Institute for Healthcare Improvement’s Triple Aim Initiative: To improve the patient experience of care, improve population health, and reduce the per capita cost of healthcare.
The premise behind the Triple Aim was that if patients had better access to information about their health, along with the ability to schedule appointments and better communicate with their providers, their satisfaction and outcomes, and thus costs, would improve. While 90 percent of hospitals offer portals as a result of the requirements, actual usage by patients is stagnant, reaching a meager 15 percent. Understandably, healthcare providers are frustrated by this, and as a result of their frustration have become intent on showing the symbiotic benefits of these patient portals.
Ironically, higher performing organizations, like Kaiser Permanente, have reported much higher rates of patient portal use—upwards of 45 percent adoption by patients in some cases. This supports the case for the patient portal by demonstrating its direct correlation to satisfying Triple Aim initiatives, yet healthcare organizations still struggle to engage their patients. For many organizations, limited functionality and the use of multiple portals with multiple log-in requirements from the same hospital system are a big barrier to patient adoption. To encourage portal usage, healthcare organizations need to address the root of the problem – selecting the wrong patient portal for your organization.
Here are five keys to selecting a patient portal solution that will encourage adoption and help healthcare organizations achieve the Triple Aim:
People perform better if they have a vested interest in the outcome of a given situation. Employees who are given an ownership stake in their company historically perform better and enjoy a higher degree of satisfaction from their respective jobs than do their non-stake-holding counterparts.
Recent research has shown that a similar premise holds true in healthcare. Patients who are engaged in their own care generally have better outcomes and enjoy higher satisfaction in the care they received. According to the American Journal of Managed Care, “A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence and motivation to make effective decisions and take action to maintain or improve one’s health.”
According to a 2016 New England Journal of Medicine survey of 340 U.S. healthcare executives, clinician leaders and clinicians at organizations directly involved in healthcare delivery, 42 percent of respondents indicated that less than a quarter of their patients were highly engaged, and more than 70 percent reported having less than half of their patients highly engaged. And to underscore the importance of this result, 47 percent of those surveyed revealed that low patient engagement was the biggest challenge they faced in improving patient health outcomes.
This is not only true for hospitals, but also for specialty care practices. In these environments, it is imperative that practices understand the very specific needs and behavior of their patients, so they can determine how best to conduct effective outreach that will increase patient engagement and patient portal utilization.
Importance of User Interface
A results-driven (or high performance) patient engagement platform helps turn patients into partners in their own healthcare. In addition, a proper next-generation solution supports compliance with MIPS (Merit-based Incentive Payment System), a component of MACRA (Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act), and with meaningful use (MU), by providing patients the ability to view, download or share their medical record. Payback is many-fold: In addition to helping providers meet regulations through a user-friendly interface, patients are freeing up time for caregivers to spend with them by self-populating data fields that would previously have been handled by caregivers. This streamlining of the patient intake process delivers significant time and cost savings to the practice.
Equally important is a patient portal that helps patients remain engaged while enabling practices to comply with government requirements under meaningful use and the MACRA regulations, thereby increasing Medicare payments and minimizing takebacks. It is imperative that the patient portal seamlessly integrates with the organization’s electronic health record (EHR), health information exchange (HIE) and accountable care organization (ACO), if the practice is participating in one. Ideally, the solution should be able to adapt to any healthcare facility’s IT system—not the other way around. Patient engagement initiatives should permeate the practice’s entire healthcare ecosystem.
People perform better if they have a vested interest in the outcome of a given situation. Employees who are given an ownership stake in their company historically perform better and enjoy a higher degree of satisfaction from their respective jobs than do their non-stake-holding counterparts.
Recent research has shown that a similar premise holds true in healthcare. Patients who are engaged in their own care generally have better outcomes and enjoy higher satisfaction in the care they received. According to the American Journal of Managed Care, “A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence and motivation to make effective decisions and take action to maintain or improve one’s health.”
According to a 2016 New England Journal of Medicine survey of 340 U.S. healthcare executives, clinician leaders and clinicians at organizations directly involved in healthcare delivery, 42 percent of respondents indicated that less than a quarter of their patients were highly engaged, and more than 70 percent reported having less than half of their patients highly engaged. And to underscore the importance of this result, 47 percent of those surveyed revealed that low patient engagement was the biggest challenge they faced in improving patient health outcomes.
This is not only true for hospitals, but also for specialty care practices. In these environments, it is imperative that practices understand the very specific needs and behavior of their patients, so they can determine how best to conduct effective outreach that will increase patient engagement and patient portal utilization.
Importance of User Interface
A results-driven (or high performance) patient engagement platform helps turn patients into partners in their own healthcare. In addition, a proper next-generation solution supports compliance with MIPS (Merit-based Incentive Payment System), a component of MACRA (Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act), and with meaningful use (MU), by providing patients the ability to view, download or share their medical record. Payback is many fold: In addition to helping providers meet regulations through a user-friendly interface, patients are freeing up time for caregivers to spend with them by self-populating data fields that would previously have been handled by caregivers. This streamlining of the patient intake process delivers significant time and cost savings to the practice.
Equally important is a patient portal that helps patients remain engaged while enabling practices to comply with government requirements under meaningful use and the MACRA regulations, thereby increasing Medicare payments and minimizing takebacks. It is imperative that the patient portal seamlessly integrates with the organization’s electronic health record (EHR), health information exchange (HIE) and accountable care organization (ACO), if the practice is participating in one. Ideally, the solution should be able to adapt to any healthcare facility’s IT system—not the other way around. Patient engagement initiatives should permeate the practice’s entire healthcare ecosystem.
Engaging for ACOs, Triple Aim
Originally a concept born of healthcare reform, accountable care organizations (ACOs) were initially little more than a way of redefining the shared responsibility of doctors and hospital staff to coordinate care, improve quality and lower costs. It did not, however, specifically examine the role of the patient. That all changed when the Affordable Care Act (ACA) came along and the ACOs were officially codified into law. Furthermore, the law also recognized that ACOs could not succeed without patient engagement. According to the IHI, “quality,” in this case, is defined from the perspective of an individual member of a given population, hence the logical focus on patient-centric care and patient engagement.
Guest post by Kate Jester-Brod, vice president of client success, EoScene.
Kate Jester-Brod
Since Hurricane Katrina, the healthcare industry has been pushing towards maintaining comprehensive EHRs. The concept of an EHR combined with the concepts of the health information exchange (HIE) creates a means for patients and providers to always have a 30,000-foot view of the patient’s health. Which then begs the question, ‘what about the actual healthcare facilities?’ What does their 30,000-foot view look like? Are facility and staff doing their part to support exceptional and safe patient care?
In the most basic of explanations, enterprise risk covers the overall opinion of others towards your organization. It can affect revenue, staff retention, grant funding, and much more. In the healthcare industry, the enterprise is at risk at many levels. Drug safety, staff and patient safety, clinical outcomes, facilities maintenance, public relations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are some but not all of the components of enterprise risk.
Moreover, reducing enterprise risk in any industry includes reducing not only overhead and operational costs but also consumer costs. In healthcare reducing costs for consumers can increase patient satisfaction, which is an obvious connection. More interesting, however, are recent news stories reporting on suits against major hospital systems for frauds and schemes—or applauding them for lowering healthcare costs.
While telemedicine and home health are increasingly major components of healthcare, much of healthcare operates in a facility like a hospital or clinic. Facilities, along with structural integrities and heating, ventilation, and air (HVA) systems, also include patient equipment and a state of cleanliness. All of these components comprise the environment of patient care and healing, and the enterprise. By taking control of these areas a hospital or healthcare facility becomes one step closer to protecting the enterprise.
The best way to protect it is to predict and manage risk before problems happen. This is even more critical as the healthcare industry works towards the Institute for Healthcare Improvement’s Triple Aim as a means to optimize care. The three components of the Triple Aim complement and overlap the need to reduce enterprise risk.
Fundamentally, the Triple Aim works towards creating system-level metrics to measure success. Enterprise risk is at the center of these metrics that ultimately drive decision making. Understanding the policies and procedures that make up facilities management, patient safety, accreditation, and the overall health of the system can significantly reduce enterprise risk while supporting more effective decision making.
Taking control of facilities management can directly impact the reduction of enterprise risk. Facilities Management holds many different responsibilities in a healthcare system, including emergency management, fire safety, patient and staff safety, infection prevention, environmental services, utilities and equipment, accreditation, and many others.
Improving patient-centered care with consideration for facility compliance results in tangible ways to improve the Triple Aim. The electronics health record is assumed to document all the components of the Triple Aim, but this clinically based monitoring system focuses on provider-patient experience and overlooks other components of the healthcare environment.
Utilizing facilities information technology plays a critical role in establishing the foundation necessary to achieve positive results in achieving the Triple Aim. Recent innovation in health facilities IT has resulted in quality improvement and measurement from the ground up and has the potential to address an often overlooked component of that we all strive for in Triple Aim.
Guest post by Abhinav Shashank, CEO & Co-founder, Innovaccer.
Abhinav Shashank
Whatever we do in the healthcare space, it is eventually meant for the greater good of patients, which is why today the aim of modern healthcare is shifting towards value-based reimbursement and with that the process is getting modified accordingly. Gradually, patient-centric care is becoming prevalent. The current standards require enhanced patient experience, and that comes with improved quality, coordinated care at a reduced cost.
CMS when releasing the fact sheet for Hospital Value-Based Purchasing Program for the year 2016, said in a statement, “We now pay hospitals for inpatient acute care services based on the quality of care, not just the quantity of services provided.” Backing this statement was the fact that out of the four quality domains, patient experience of care bore 25 percent of the weight. This led to hospitals working earnestly towards enhancing the patient experience and utilizing the massive potential to qualify for the bonus and improve on current standards.
Why does Patient Experience Matter?
Patient experience is an essential component of the IHI Triple Aim, a schema for elevating the standards of providers’ performance:
Improving the patient experience of care.
Improving population health.
Reducing the per capita cost of healthcare.
Fortunately, health systems know that patient satisfaction isn’t just a tool for a performance bonus. Improving patient satisfaction is a way to identify gaps in care delivery and develop quality services. Also, according to a survey conducted by a health system found that out of 1,019 adults interviewed, 85 percent were dissatisfied with at least one aspect of their providers. Creating a patient-centric industry where experience and satisfaction of patients are overlooked is almost impossible!
Improving Patient Experience
A lot of researches have established that improving patient experience directly results in higher quality of care. Healthcare systems have realized the importance of the Triple Aim, and here’s how they can start working in this order on improving one of the fundamental aspects:
Patient Engagement a Priority
Patient engagement has been one of the most talked-about aspects of healthcare and unquestionably a way to improve the care experience. What we need to ensure is that the patient is willing to participate in the decision-making and the provider advocating this intervention. Even though healthcare providers are making efforts to improve patient engagement at their end, a survey revealed that only 34 percent of the patients are highly encouraged. Some effective methods patients found useful are:
59 percent of the surveyed people found increased physician-patient time vital.
54 percent of the patients favored being part of the decision-making.
36 percent promoted the growth of patient access to services.
Using Data Analytics
Data analytics have proven their worth in healthcare, and we have only scratched the surface of the immense sea of possibilities that can be realized using data analytics. When it comes to advancing patient experience, data analytics can be used in several ways:
Gathering data and creating actionable follow-up plans for patients.
Leveraging data analytics for accurate analysis of patients and reducing readmission rate.
Data analysis can zero in on inefficiencies and medical errors and help reduce avoidable expenses.
Guest post by Christina Richards, vice president, AOptix.
Christina Richards
In recent years, the healthcare industry has experienced a Renaissance of sorts with the development and adoption of mobile and connected technologies. As a result, healthcare facilities the world over are increasingly making use of smart technologies to drive better patient outcomes, track equipment, and support overall operations. In addition, the developing practice of telemedicine is becoming increasingly commonplace for doctors in healthcare settings across the United States, which is raising new concerns about the infrastructure needed to support these real-time doctor-patient experiences.
Although the development of these digital technologies for healthcare applications is only in its infancy, we are already beginning to see their wide range of benefits, including the potential to help organizations achieve the Institute for Healthcare Improvement’s (IHI) Triple Aim of bettering the patient experience, improving population health standings and reducing the cost of healthcare. For instance, a 2014 study by Dale H. Yamamoto of Red Quill Consulting, Inc. found that that the average estimated cost of a telehealth patient consultation was $40 to $50 per visit, compared to the average estimated cost of $136 to $176 for in-person acute care.
With the widespread adoption of any new technology however, there is a learning curve to ensure that they can be effectively integrated into existing operations to capture the greatest benefit without compromising the level of care. But what does this entail?
Data
As healthcare facilities become more connected through the Internet of Things, adoption will continue across a broad spectrum of devices and sensors—from wearable tech that monitors patient location and vital signs to analytics platforms that track staff movements and create more efficient workflows. While these devices span a variety of applications, they all share a universal purpose, which is the constant collection and analysis of data.
Likewise, video conferencing and other mobile approaches to telehealth are highly data-intensive, requiring the transmission and processing of large amounts of information. As a result, many healthcare administrators have encountered the need for far more robust mobile networks in their facilities to support the massive amounts of data traveling across their systems.
In considering other data requirements on the horizon, take the case of rapid genomic sequencing. While the new technology allows researchers to quickly determine the complete DNA sequence of an organism to predict disease susceptibility and drug response, the process requires the transfer of massive amounts of data. To make this information more widely accessible, one company, NantHealth, is looking into a method of compressing the data into a more manageable size so it can be shared with other facilities through high-capacity wireless connections, rather than strictly relying on fiber. With ever-growing levels of data becoming necessary in the healthcare system, new technologies and methods for managing it across various networks will become even more important.
The Triple Aim framework has emerged as a guiding principle for healthcare organizations seeking to optimize patient care outcomes while simultaneously containing costs.
