By Douglas McCarthy and Sarah Klein
In October 2007 the Institute for Healthcare Improvement (IHI) launched the Triple Aim initiative, designed to help healthcare organizations improve the health of a population and patients' experience of care (including quality, access, and reliability) while lowering-or at least reducing the rate of increase in-the per capita cost of care. Pursuing these three objectives at once allows healthcare organizations to identify and fix problems, such as poor coordination of care and overuse of medical services. It also helps them focus attention on and redirect resources to activities that have the greatest impact on health.
Without balanced attention to these three overarching aims, healthcare organizations may increase quality at the expense of cost, or vice versa. Alternatively, they may decrease cost while creating a dissatisfying experience for patients. Many problems that healthcare systems face can be linked to one or more of these objectives. Problems like supply-driven care, preventable readmissions, and overbuilding may represent a failure on all three counts.
While easy to understand, the Triple Aim is a challenge to implement. Various forces and traditions have encouraged physicians and hospitals to focus on acute and specialized care over primary and preventive care and to think narrowly about care for particular conditions or episodes of care for individual patients, without considering the health of a population.
To achieve the Triple Aim, healthcare organizations must broaden their focus to organize care to meet the needs of a defined population. Payers, especially those with little direct influence on health outcomes and patient satisfaction, find they must forge new kinds of partnerships with providers. Success requires a willingness to take on new roles and a com¬mitment to honest self-appraisal-otherwise it is easy for healthcare organizations to continue to work on objectives that play to their existing strengths and neglect those that do not.
Lessons from organizations that are pursuing the Triple Aim can guide others who wish to undertake or promote transformation in healthcare delivery.
CareOregon. An Oregon-based not-for-profit managed health care plan, CareOregon partnered with safety-net clinics to optimize care for low-income enrollees by developing two innovative programs: a patient-centered medical home initiative in safety-net clinics and a multidisciplinary case management program for members at high risk of poor health outcomes.
The health plan engaged its independent providers in carrying out these programs by creating learning communities through which the providers could acquire, share, and practice techniques to realize the objectives of the Triple Aim. By partnering with healthcare providers to create and pursue a common vision for improving primary care delivery, CareOregon is transforming its role from a payer to an integrator of care on behalf of its members.
Early results include the following:
Genesys Health System. A not-for-profit integrated health system based in Flint, Mich., Genesys Health System partnered with its affiliated physician-hospital organization and a tax-supported county health plan for the uninsured to develop a model of care known as HealthWorks.
HealthWorks embodies three key elements:
As more organizations adopt the goals of Triple Aim and share unique and successful approaches to the challenging problems of coordination of care, chronic disease management, and preventive health, the program is likely to yield more innovations that can be extended to a variety of settings. With time, evidence is likely to accumulate on the effectiveness of such models in improving population health, controlling costs, and improving patients' experience of care. With that combination of experience and evidence, the programs they have pioneered may become more commonplace.
Douglas McCarthy is president, Issues Research, Inc., Durango, Colo., and senior research advisor, The Commonwealth Fund (firstname.lastname@example.org). Sarah Klein is a reporter.
This article is excerpted with permission from a longer piece on this topic by the authors: D. McCarthy, D. and Klein, S., The Triple Aim Journey: Improving Population Health and Patients' Experience of Care, While Reducing Costs, The Commonwealth Fund, July 2010.
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