History and Purpose of Triple Aim
The Institute of Healthcare Improvement (IHI) researchers claimed that for the healthcare system of the USA to be improved, a system of connected goals should be pursued (Whittington et al., 2015). The new system was called Triple Aim, and it was to bring change to both individuals and society. The purpose of triple aim is to enhance individual healthcare experience, enhancing care for populations and minimizing the price of healthcare services for populations. The research also highlighted foundational principles from which the triple aim work will be achieved. The three principles include pursuing Triple Aim simultaneously, identifying a population that is at risk and assigning an integrator with certain unique functions and roles. These principles are referred to as “small theory.” A small theory must be refined and tested within different contexts and several sites before it is adapted.
IHI researchers established a collaborative mechanism to begin refining and testing the small theory of Triple Aim in 2007 (Whittington et al., 2015). The organization started recruiting other organizations all over the world to take part in a collaborative to initiate the small theory. The 141 organizations that were involved in the development of triple aim include hospitals, health care systems and insurance bodies, organizations linked to health care, and key teams that are not represented in health care such as social services teams, community coalitions and public health agencies.
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The first design developed by IHI during the 1990s was called the IHI Breakthrough Series Collaborative paradigm. The model provided an avenue where several sites that had a similar aim of collaborating and real-time sharing both unsuccessful and successful approaches. The results of the mechanism include a transparent measure of the progress of teams that performed best, which led to improvement and motivation. Collaborative work provides an observational research structure. Using this design, IHI endorsed multiple organizations in several collaborative efforts to adapt the Triple Aim theory and refine it. The case-control approach that was used, was based on the progress of different sites. The measure of progress used involved showing improvement in the measures of outcome related to the small theory or the measures of process related to the design of the site (Block, 2014). Contrasts in structures and contexts of the sites that did not indicate progress and those that showed progress were noted.
After seven years of collaborative work between IHI researchers and multiple organizations through following their progress and work, an ex-post theory was developed to determine why other sites made progress, and some did not. It was established that pursuing triple aim necessitates three primary constituents; developing a valid base for managing populations, governing at scale services for the community and creating a method for learning to sustain and drive Triple Aim activities for many years (Block, 2014). These core components strengthen the program theory aimed at forming the foundation for future testing and achieving the triple aim.
The success of the triple aim is crucial in the steps to achieve a health care system that is moving towards value-based payment systems. The framework also urges leaders in healthcare systems to incorporate its principles to improve the overall health of their communities beyond clinics and hospitals which are part of the health care system. There are several steps that healthcare organizations can take in the smooth implementation of triple aim. Some of these steps are the identification of populations at risk and the unique needs of each population, developing system-specific and organization goals and establishing a means of measuring, tracking and demonstrating progress (Williams, 2016). The three core areas of triple aim are improvement of individual experience, better per capita costs of health care and improvement of care for groups of people.
Enhancing Patient Experience
Improving individual health care encounter is one of the facets of the initiative. To effectively achieve this and the population health, the overall health of the community should be assessed by health care systems that serve them. Any existing issues and risk areas should be identified, and the community's overall mortality assessed. Several initiatives have been established in the last decade to facilitate easy navigation through the health care system by patients. One of the initiatives is improving communication between the patient and care providers in the community (Williams, 2016). Examples of changes that have been implemented in healthcare systems throughout the USA include Accountable Care Organizations (ACOs), patient care coordination groups, shared decision making, Managed Care Organizations (MCOs) and Electronic Health Records (EHR). The progress of these changes can be tracked through measures of quality improvement and surveys of patient satisfaction.
Reducing Costs
The cost minimization facet of this initiative encourages organizations to come up with ways of minimizing costs of health care and increase the quality of service, while at the same time identify populations at risk and address their health concerns. The US healthcare system makes up seventeen percent of the nation’s (GDP) and is anticipated to reach twenty percent by 2020 (Coyne et al., 2014). Consequently, this makes it the most costly health care program in the world. As the value of health care is increasing, the quality of services being offered is the same. On the contrary, other parts of the world experience a higher quality of health care at an affordable cost. Therefore, America is determined to enhance the quality of services and minimize their costs. Many factors affect the cost and quality of health care being offered in any country. Some of these factors, such as more chronic diseases due to an ageing population, are burdensome in the USA, and this makes improving healthcare and reducing costs a complex balancing act.
Despite this, hospitals all over the country have started establishing disease-specific, targeted programs in which they work with physicians to improve the health of patients and link physicians with patients when it comes to decision making and care coordination. These programs aim to support patients with complicated and costly needs through education, treatment and motivation. Besides, successful care innovations will result from working collaboratively with patients since the patients will have an opinion on treatment plans (Williams, 2016). Healthier patients will not consume services frequently while those with chronic conditions and have no regular access to healthcare services will receive them as economically as possible in their community hospitals.
Improving Population Health
Lastly, the triple aim focuses on determining and addressing risks within populations. Everyone who lives in a community where there is a health care organization can get sick. Stakeholders should understand the most likely causes of community members to attend a healthcare facility to ensure organizations establish preventive strategies that moderate costs and offer patient-centered, coordinated and improved services (Coyne et al., 2014). In America, improvement of the society's health has been achieved through bundled payments and innovative financing methods, such as new mechanisms of medical care, which include incorporation of information technology, patient-centred medical homes, and hospital readmissions. Health care organizations are recommended by IHI to design new care models that serve their communities in achieving triple aim interdependent goals, which are involving families and individuals in innovating care models, reestablishment of medical care facilities and, enhancement of health promotion and prevention of disease, building a platform for cost control, and incorporation and execution of a support mechanism.
Current Effect on Healthcare Delivery
Successful achievement of an appropriate balance in the three facets of triple aim is the driving force behind this framework and is crucial in achieving real long-term change in delivery outcomes of medical care (Block, 2014). One of the effects of the framework in delivery outcomes is healthy populations. The new designs that have been implemented in the framework help health care systems to determine problems and their solutions outside intense health care better. Secondly, patients will receive less complicated and more coordinated care. As a result, the burden of chronic illnesses will reduce (Evans, 2017). Thirdly, decreasing the per capita expenses on health care for societies will ensure businesses are competitive, reduce the pressure on government-funded care budgets and give communities a flexible chance to engage in activities that improve the economic wellbeing and vitality of its members.
Many medical care organizations are making progress in achieving the goals of this framework, and therefore, evidence will assist in refocusing the direction of the overall health care system of America. However, consistent, sustained work to minimize cost, improve quality of care and ensure coordinated and patient-centred care is provided will remain top priorities of this framework (Evans, 2017). As more organizations within the design invest in and put innovative measures in place to improve healthcare delivery, change throughout the nation will be inspired to benefit payers, patients and healthcare providers.
References
Block, D. J. (2014). Revisiting the Triple Aim--Are We Any Closer to Integrated Health Care? Physician Executive , 40 (1), 40–43.
Coyne, J. S., Hilsenrath, P. E., Arbuckle, B. S., Kureshy, F., Vaughan, D., Grayson, D., & Saygin, T. (2014). Triple Aim Program: Assessing Its Effectiveness as a Hospital Management Tool. Hospital Topics , 92 (4), 88–95.
Evans, J. (2017). Rethinking Health Care’s Triple Aim. Hfm (Healthcare Financial Management) , 1–7.
Williams, R. (2016). Engaging patients to achieve the Triple Aim. Healthcare Financial Management , (9), 72.
Whittington, J. W., Nolan, K., Lewis, N., & Torres, T. (2015). Pursuing the Triple Aim: The First 7 Years. Milbank Quarterly , 93 (2), 263–300.
