Triple AimThe Institute for Healthcare Improvement (IHI) launched the Triple Aim initiative over 10 years ago, back in 2007. It was created for healthcare organizations to enhance a patients’ experience (i.e. quality, access, and reliability) while reducing the per capita cost of care.

Following these three Triple Aim objectives enables healthcare organizations to recognize and solve problems such as poor coordination of care and excessive use of medical services. It also encourages organizations to focus attention on and redirect resources to action that produce the most considerable impact on health.

  1. Improving the patient experience of care
  2. Improving the health of populations
  3. Reducing the per capita cost of health care

Why the Triple Aim?

 The United States healthcare system is the most costly in the world, accounting for 17% of the gross domestic product with estimates that percentage will grow to 19.9% of GDP by 2022. At the same time, countries with health systems that out-perform the US are also under pressure to acquire greater value for the resources devoted to their healthcare systems. Aging populations who are living longer, along with with chronic health problems, have become a global challenge, putting new pressure on medical and social services.

Without proportionate attention to these three overarching aims, healthcare businesses may increase quality at the expense of cost. Or, the opposite could be true as well; reduce cost but produce an unsatisfactory experience for patients. Many issues that healthcare systems deal with can be attributed to at least one of these objectives.

While easy to understand, the Triple Aim isn’t necessarily easy to achieve. Physicians and hospitals are accustomed to focusing on acute and specialized care. versus primary and preventive care. To attain the Triple Aim, healthcare organizations need to expand their attention to treat the needs of a defined population.

Triple Aim’s History

To roll out the first stage of the Triple Aim initiative, IHI researched organizations that could serve as prototypes of “macro-integrators” — linking providers across a continuum of care — to optimize service for a defined population. Each of the selected organizations were dedicated to bring together different constituencies — including nursing and medicine, medical care and public health, and specialty care and primary care physicians — to fulfill the Triple Aim’s goals. These objectives are carried out at the frontlines by “micro-integrators”—the care providers and teams or community organizations that interface with patients and their families.

The first group of macro-integrators in the Triple Aim initiative were made up of 15 organizations, such as hospital-based systems, health plans, employers, and social service agencies in the United States, England, and Sweden. Participation in the initiative quickly expanded to 40 organizations, including sites from the U.S. and abroad. In 2010, IHI embarked on the fourth phase of the project with 60 sites from all over the world participating in the initiative.

IHI assisted the organizations to translate the Triple Aim concept into a specific plan for change. Each organization had to specify the population to focus their testing. Then, each participating site was asked to develop measures of per capita cost, experience of care, and health status for that determined population. The process shifted the focus away from the outcomes of individual institutions and providers, to population health instead.

IHI directed the participants to implement five principles when designing a new model of care:

  • Involve individuals and families when designing care models
  • Redesign primary care services and structures
  • Improve disease prevention and health promotion
  • Build a cost-control platform
  • Support system integration and execution

Coinciding Goals

 The components of the Triple Aim are not independent of one another. Sometimes changes can have a positive or a negative impact, because one goal can affect the others. Newer technology may improve care, but it may also increase the cost of care. On the other hand, reducing overuse of diagnostic tests can lower costs and improve outcomes. Patience is a virtue when quantifying outcomes of these efforts as quality preventive care could take years to provide returns in cost and/or population health.

The most notable component is a population-based approach, which requires building a strong partnership between the macro-integrator organization (i.e. health plan, health system, purchaser) and the micro-integrators (i.e. care providers or community organizations) to evaluate whether resources were being optimally executed to meet the needs of their population.

Conclusion

As the Triple Aim becomes a more common practice among healthcare organizations, communities will have healthier populations. Patients can anticipate more coordinated, cohesive care, and the burden of illness will decline. Over time, the success of these models in improving population health, controlling costs, and making patients’ experience better will become even more evident.

Additionally, stabilizing or reducing the per capita cost of care for populations will give businesses the chance to be competitive, reduce the stress to publicly fund healthcare budgets, and equip communities with more flexibility to invest in other activities, such as schools.

Be sure to check-in later this month — our next blog will cover how to implement and achieve the Triple Aim.

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