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The Triple Aim of Health Care

The Triple Aim is a framework that healthcare systems can use to better meet the needs of individual patients, patient populations, and healthcare organizations. There are three overarching goals that make up the Triple Aim of healthcare: reducing per-capita costs, improving population health, and enhancing quality of care for individual patients. 

The three components of the Triple Aim framework can help guide health care systems toward better results by providing clear focuses and measurability. But the Triple Aim has also been expanded in recent years to include more areas of concern, like health equity and provider burnout. This is sometimes called the Quintuple Aim.

With the Triple Aim of healthcare becoming more complex, healthcare providers need support to achieve its goals. Chronic Care Management shares the Triple Aim’s focus on reducing costs while improving patient care. A fully managed CCM program can support the goals of the Triple Aim, while also helping providers avoid burnout and treat patients equitably.

What Is the Triple Aim in Healthcare?

The Institute for Healthcare Improvement (IHI) developed the Triple Aim of Health Care in 2007. In the years since, more than 1,542 healthcare professionals have cited the Triple Aim in peer-reviewed articles, and the Triple Aim has been recognized by the National Committee for Quality Assurance and the Joint Commission. 

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 reducing per-capita costs, improving population health, and enhancing patient quality of care.

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 Per-Capita 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 in the years since IHI created the Triple Aim. In 2023, U.S. health care spending hit $4,666 billion. Per person, the U.S. spends 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 16% of the U.S. population. 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. Increasing the Overall Health of the Population

The goal of increasing population 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 serious health 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 or practice's services. 

Proposed Expansions to the Triple Aim

In 2018, Dr. Salvatore Lacagnina proposed a fourth goal to add to the Triple Aim: improving the lives of providers, with a focus on preventing burnout and protecting their mental health. In 2022, Drs. Shantanu Nundy, Lisa A. Cooper and Kedar S. Mate proposed a fifth goal, increasing health equity. 

The Institute for Healthcare Improvement has embraced these changes, inviting Dr. Mate to publish a piece on their site about The Quintuple Aim. Some healthcare organizations may opt to work on all five goals, instead of the initial three. 

1. Workforce well-being and safety

Many providers struggle with overwhelming workloads, often seeing a new patient every 15-20 minutes or working 12-14 hour days. This also puts a tremendous amount of stress on the medical staff who work alongside them. Providers already spend an average of 15.5 hours per week on administrative tasks, and implementing new value-based care programs can add even more work if done in-house. While developing value-based care programs that offer preventative care to patients, providers must ensure they choose programs that don’t overwork them or their staff. 

2. Advancing health equity

Advancing health equity is closely tied to improving the patient experience and population health. However, it requires recognizing that interventions that improve the health of one population may not work for all populations. 

To move toward health equity, healthcare systems must involve people from historically underrepresented groups in designing and delivering healthcare initiatives. Practices must also address Social Determinants of Health, like transportation, housing, and access to nutritious food.

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 or fee-for-service 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.

Having more patient encounters is helpful when those patients are receiving more preventative care, like cancer screenings, vaccinations, and eye exams. Investing in volume for upstream settings, like preventative care programs, telehealth, urgent care, and primary care practices, can help providers give patients a better overall experience and higher quality of care. This can also prevent some costly and unnecessary visits to the ER.

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 practices may be well-intentioned, value-based care initiatives can easily fall to the back burner, leaving patients with chronic illnesses without the support they need.

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 value-based care models, like ACOs and the Medicare Shared Savings Program. 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:

• Help the patient build a care plan.
• Help the patient create specific care goals.
• Schedule follow-ups.
• Write documentation.
• Assist with organizing transportation and finding Social Determinant of Health resources.
• 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 help patients create preventative care plans that are approved by their provider. CCM can also allow patients and providers to stay on the same page regarding the progress of the patient's conditions.

For example, say Joe’s provider discovers two chronic conditions when he goes in for his Annual Wellness Visit (AWV). His provider explains what CCM is, and Joe gives his consent to enroll. 

The CCM care coordinator, who can work for the provider’s office or be partnered with the provider, will then call the patient and help them create a care plan. The coordinator can also request records from specialists and primary care providers to update Joe’s files. 

CCM can even integrate with providers’ Electronic Health Record (EHR) for easy access to the information collected. With CCM, Joe and his entire network of providers are able to stay up-to-date about his condition.

CCM supports each element of the Triple Aim:

• Reducing costs: A CCM program employs multiple revenue streams — including fee-for-service and value-based care — to deliver profitability for practices. At the same time, CCM health care organizations can expect a reduction in costs per patient, per year. In fact, ChartSpan customer claims data showed a $2,457 reduction in total annual costs per patient in 2023.Overall, the program reduces 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, ChartSpan claims data shows that patients who are enrolled in its CCM program see 13% fewer readmissions.
• Enhancing 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. This remote care is especially critical for patients at Federally Qualified Health Centers (FQHCs), who may lack transportation, and patients at Rural Health Clinics (RHCs), who may live an hour or more from the closest in-person provider. Both FQHC and RHC patients are also likely to have SDOH needs–like food, transportation, and housing–that care coordinators are able to address.

A CCM program can also support the two additional components of the Quintuple Aim:

• Address burnout among the healthcare workforce: Introducing value-based care initiatives can overwhelm practices that already have a heavy workload. This is why many practices choose to employ a CCM partner, who can perform the administrative work of enrolling patients and providing CCM services each month. CCM care coordinators can manage calling patients, working on care plans and care goals, setting up appointments, requesting medication refills, finding SDOH resources, and other tasks that would take up practice’s staff valuable and limited time. 
• Increase health equity: Patients with socioeconomic barriers are more likely to miss out on preventative care. Chronic Care Management can help by giving patients more affordable care at home, so they’re less likely to require expensive visits to urgent care or the emergency room. CCM care managers are also trained to screen for SDOH needs and connect patients to local resources for nutritious food, safe housing, new clothing or hygiene products, and affordable transportation.

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. CCM lowers both per-patient costs and hospital readmission rates.
• 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. You can also explore healthcare accessibility by surveying people about how often they seek out medical care, whether it’s difficult for them to access care, and what factors would make it easier.  ChartSpan regularly conducts screenings to evaluate how patients feel about their healthcare experience and which of their needs are or aren’t being met.
• Burnout among the healthcare workforce: Hold anonymous surveys of your workforce to determine what challenges they’re facing and whether they’re suffering psychological effects of burnout. You can also examine how often resources like Employee Assistance Programs are being utilized. 
• Health equity: Collect demographic data when measuring patient experiences, functional status, hospital readmission rates, mortality, and other health indicators. If a certain population is having worse health outcomes than others, you know you need to reimagine your initiatives to better serve that population.

These measurements are a crucial part of working toward the Triple or Quintuple 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 or Quintuple 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 businesses 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 around-the-clock access to care and assistance, while providers get regular updates on their patients without strain on in-house resources. We'll help you with every step, from identifying eligible patients to providing a 24/7 nurse line and monthly care. 

Learn more about how ChartSpan can help you achieve the Triple or Quintuple Aim of health care by reaching out to us today!