The Triple Aim of Health Care
Amidst all the goals of health care professionals, three stand out as overarching guideposts for the industry — reducing costs, improving patient health, and improving quality of care. These three goals make up a framework that health care systems can use to better meet the needs of individual patients, populations, and organizations: The Triple Aim.
The three components of the Triple Aim framework help to guide health care systems toward better results through clear focus and measurability. Let’s explore the Triple Aim and what it means for health care organizations.
What Is the Triple Aim?
The Institute for Healthcare Improvement (IHI) developed the Triple Aim in 2007 in response to rising health care costs and pressure to deliver more value despite aging populations and chronic health issues.
The Triple Aim’s goals span all levels of a health care system, from small private practices to national insurance providers. The framework aims for every member of the health care system to work toward these goals and balance the need for better care and patient experiences with the need to save costs.
Rather than following a sequential process from one goal to another, the IHI Triple Aim framework emphasizes these three goals’ interdependence. In other words, you can’t achieve one goal without the others.
1. Reducing Costs
The first goal of the Triple Aim encourages organizations to control costs more effectively and ensure more value from every dollar spent on health care.
The U.S. health care system is one of the most expensive in the world, with prices that have only gone up since the development of the IHI Triple Aim. In 2020, U.S. health care spending hit $4.1 trillion. Per person, that’s about three times as much as the average cost in the Organisation for Economic Co-operation and Development’s 38 countries. Major contributors to these high costs include:
- An aging population: People tend to experience more chronic conditions as they age, and people 65 and overspend more on health care than any other age group. According to the U.S. Census Bureau, this group will account for more than 20% of the population by 2030. Higher costs also signal a spike in Medicare enrollments, which is likely to increase the costs of the program.
- Increasing costs of health care services: While the Consumer Price Index (CPI) for all goods has grown 2.1% since 2000, the CPI for medical care has grown by 3.5%. These rising costs could be the result of new, innovative technologies that call for more expensive products and procedures. However, they may also come from complex systems with excessive administrative waste. The consolidation of hospitals is another potential factor, as it allows providers to increase prices without many competitors.
These costs might be acceptable if they were leading to improved health outcomes. However, despite higher spending, the quality of U.S. health care lags behind other countries across several measures, including disease burden, treatment outcomes, and maternal mortality rates.
It’s clear that not all of the costs in the health care system are justified. Reducing them can help direct resources where they’re actually needed. Freeing these resources will help providers reach the other two goals, further helping to control costs.
2. Improving the Overall Health of the Population
The goal of improving patient health has a natural place in the Triple Aim, guiding health care systems through assessing and improving the health of the populations they serve.
Organizations work toward this goal by identifying and addressing risks for specific communities and determining what prompts community members to engage with the health care systems. These insights can fuel new initiatives and policies directed at closing gaps in care.
Many people assume that health care is only necessary if they become ill or injured. Population management urges health care organizations to take a proactive approach. Ongoing measures like patient-centered, value-based care initiatives can prevent these issues before they start, boosting community health.
3. Improving the Individual Patient Experience
The Triple Aim’s final goal encourages health care organizations to assess the needs of their communities and use those insights to help patients navigate and access care. This assistance might look like implementing a portal that allows patients to access their information and communicate with providers from an app or website. It could also look like participating in an Accountable Care Organization (ACO) or tracking patient satisfaction through surveys and quality improvement measures.
The health care system can be complex, with many elements that could contribute to a poor patient experience. Patients might struggle to find a provider, understand their results, or pay for services. Even with health insurance, three in 10 Americans still face a financial barrier to care, with communities of color disproportionately affected.
Although there is still debate around the idea of consumer-driven health care, it is no surprise that consumers expect a say in their care and that patient experience can reflect the quality of a hospital’s services.
How Volume-Based Care Leads to Value-Based Care
In striving for the Triple Aim, many in the industry have seen a need to move away from volume-based care, which rewards providers for seeing more patients and ordering as many tests and procedures as possible. This system certainly seems to run counter to the Triple Aim’s goals. It increases costs and can create a frustrating experience for patients. It also doesn’t necessarily improve the quality of care, especially when compensation is tied to how often patients return rather than exceptional health system performance.
The idea of value-based care arose in response to those issues, basing provider compensation on the quality of patient care rather than the number of services. However, volume-based care doesn’t necessarily need to be eliminated from health care strategies. Instead, we can shift it to a different part of the spectrum of care.
Focusing on building volume upstream in the care journey lets hospitals and health systems move patients into more appropriate settings, where value-based care can take over. Investing in volume for upstream settings like preventative programs, telehealth, urgent care, and primary care practices can help providers get patients where they need to be for a better overall experience and quality of care.
Chronic Care Management and the Triple Aim
The U.S. health care system has traditionally positioned itself as reactionary rather than preventative. Most people don’t go to their doctors unless something is wrong. While they may go in for an annual physical, there isn’t much support for ongoing care outside of this yearly checkup. Infrequent visits mean that chronic conditions can worsen, and providers may not receive all the information they need to help the patient.
Value-based care aims to change this, creating more proactive programs to get patients involved in the ongoing management of their conditions. However, when providers are already strained for resources, it can be challenging to fit preventative care into the day. While they may be well-intentioned, value-based care initiatives can easily fall to the back burner, leaving patients with chronic illnesses out of the equation.
The Centers for Medicare & Medicaid Services (CMS) created the Chronic Care Management (CCM) program to address these issues. This program reimburses providers via fee-for-service and shared savings models. CCM offers a structured system for providing value-based care while delivering the revenue stream necessary to support providers financially. It can also reduce workload by having a third-party provider take over some administrative elements of care.
CCM primarily refers to remote care delivered to Medicare beneficiaries with two or more chronic conditions. A CCM program closes the gap between the patient and provider by providing consistent, preventative care. The CCM care team can:
- Build care plans
- Identify eligible patients
- Create goals
- Schedule follow-ups
- Write documentation
- Assist with organizing transportation and home care
- Help patients refill prescriptions and make appointments
- Support caregivers and family members caring for loved ones
- Offer a 24/7 nurse line to answer patient questions and concerns
How Does CCM Help Health Care Organizations with the Triple Aim?
CCM programs fit nicely into traditional care plans and allow patients and providers to stay on the same page regarding the progress of the patient’s conditions.
A CCM program regularly reports back to the provider, delivering coordinated care and keeping everyone connected. It can even integrate with a provider’s Electronic Medical Record (EMR) for easy access to the information collected. CCM programs can care for patients with a variety of chronic conditions such as diabetes, heart issues, and even mental health disorders.
CCM supports each element of the Triple Aim:
- Reducing costs: A CCM program drives two revenue streams — fee for service and shared savings — to deliver exceptional profitability for practices. Additionally, with CCM, health care organizations can expect higher patient savings. It reduces annual costs for Medicare, taxpayers, and patients, minimizing financial barriers to care and excessive expenses in all parts of the health care system.
- Improving population health: As CCM plays a more proactive role in patient health, it can help keep people healthier and out of the doctor’s office. In fact, eligible patients who aren’t enrolled in CCM often see more readmissions.
- Improving individual care experiences: Providers and care managers can see the value of CCM through improved patient satisfaction. Patients stay connected with their care team and have greater access to resources for managing their conditions. Digital methods are becoming increasingly common tools for improving patient experiences and CCM programs also offer the flexibility of virtual connection. Virtual feedback, scheduling and digital communication with a medical team are all elements a CCM program can offer.
- Expanded patient access: Reaching a provider is challenging for many people. CCM programs improve access to care, especially for patients of Rural Health Clinics (RHCs) or Federally Qualified Health Centers (FQHCs).
How to Measure Effectiveness
Goals require a way to measure progress to determine success or failure. That’s why IHI has outlined several outcome measurement suggestions to help organizations track their progress toward the Triple Aims:
- Per capita costs: You can measure per capita costs with two metrics — the total cost per member of the population per month or the hospital and emergency department utilization rate and cost.
- Population health: Population health is perhaps the most challenging of the three aims to measure because it includes such a wide variety of factors. However, you can look at health outcomes like health and functional statuses, mortality, and healthy life expectancy. Other metrics include disease burden, behavioral factors like smoking and physical activity, and psychological factors like blood pressure.
- Experience of care: Patient surveys are a great way to measure the quality of their experiences. Measuring patient satisfaction and accessibility lets providers make data-driven changes to continuously improve their practice.
These measurements are a crucial part of working toward the Triple Aim, as they provide guidance and direction. They can prove where your hard work has paid off and help you learn where to better target your initiatives for better results through this interconnected framework.
Achieving the Triple Aim Through Quality CCM
The Triple Aim may seem like a lofty goal. However, with clear outlines and the help of a CCM program, health care organizations can follow the framework to better help patients, providers, and organizations across the health care system. CCM fills the gap between patient and provider, allowing organizations to improve outcomes, save costs, and deliver better experiences.
Here at ChartSpan, our turnkey CCM solution helps our clients do just that. Patients gain round-the-clock access to care and assistance while providers get regular updates on their patients without the strain on in-house resources. We’ll help you with every step, starting with identifying eligible patients to help you get the most out of your CCM program.
Learn more about ChartSpan and see how it can help you meet the Triple Aim of health care by reaching out to us today!
Published: July 8, 2022
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