Triple Aim: Impossible dream or bold new reality?

 By Alina Hsu

While many hospitals and healthcare providers are still struggling to provide care that is safe, effective, patient-centered, timely, efficient and equitable, IHI has raised the bar. The next step is the Triple Aim:

  • Improve the health of the population
  • Enhance the patient experience of care (including quality, access, and reliability
  • Reduce, or at least control, the per capita cost of care

In a recent blog post, Pierce Story encouraged hospitals and other healthcare providers to be bold in designing new models of care delivery for the future. In my opinion, an example of is hospital systems and HMOs that are forming strong partnerships with primary care and other service providers – and even employers – to work towards meeting the Triple Aim goals. They are doing this in spite of the constraints common across healthcare organizations in the U.S.: fragmented systems, misaligned reimbursement structures, overburdened staff, shortages of primary care physicians, etc.

One of these is Silverton Hospital Network in Oregon. In a recent article, Mark Graban and Mike Orzen show how a Lean mindset enables SHN and other hospital systems not only to improve care internally, but also to improve care across the extended value stream. They move beyond sickness care to population health. They do this through better coordination with other service providers, improving chronic care management, and patient-centered medical home initiatives.

Another is the Cedar Rapids Healthcare Alliance, which uses Lean and ISO 9001 to improve coordination, quality, and patient safety across the continuum of care. They were motivated in part by realizing that the costs of treating chronic illness account for 75% of healthcare spending. They have created a community model of care delivery and patient safety, using teams that include the whole range of community providers and stakeholders, including local businesses. You can get a good idea of their scope through this summary of their Triple Aim meeting held in September 2010. Dr. Jim Levett, a leader of this effort, credits their successes to an unusual degree of collaboration and mutual respect. (If you are a member of SHS you can check out this presentation by Dr. Levett at the SHS 2010 conference as well.)

A final example is Genesys Healthworks, which is “leading the transformation of healthcare by creating a new model of care that is focused on health, not just disease. HealthWorks is focused on achieving the Triple Aim of improving population health, improving the experience of care, and reducing healthcare costs within our community.” (emphasis in original)

Genesys’s work and achievements are especially noteworthy because they are serving a large proportion of uninsured patients. More details can be found in this Commonwealth Fund case study.

The March issue of Health Affairs (subscription required) features several more examples of hospitals and other healthcare delivery organizations that are making progress toward the Triple Aim. They report results such as reduced hospitalizations and ED visits, improved health status, improved follow-through on recommended treatments and behaviors, and gains in patient safety and satisfaction.

The structures and programs that have been found to be effective in the above examples show an appropriate variety, reflecting local context, needs and constraints. But common across all of them are: better care coordination, collaboration across the extended care continuum, a focus on preventing and managing chronic conditions, and various other kinds of patient support (medical homes, community care teams, peer support groups, etc.).

It’s exciting to see so much progress – and I’m glad to see these organizations deciding not to wait for the details of federal healthcare reform. The organizations pursuing the Triple Aim are doing the right thing for their patients, providers, employers and communities. Apart from the very real economic goals and demonstrated cost-effectiveness of their initiatives, the lives improved and saved are in a sense priceless.