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The Triple Aim developed by the Institute of Healthcare Improvement (IHI) is a three-dimensional model of the US healthcare system development. The main goal of this framework is to reform all aspects of the healthcare system performance by improving patients’ experience and overall health of the population as well as reducing the cost of the health care per capita. According to the IHI’s belief and vision, all these three dimensions, working together, will improve the current condition of the healthcare system in the USA. Nowadays, the US healthcare system is found to be one of the most expensive in the world, and it is expected to rise even more in the upcoming years due to the increase in both overall lifespans of the population and cases of chronic medical diseases. For the framework to be effective, all of three dimensions should work simultaneously.
The first part of the Triple Aim is focused on the improvement of the overall experience of patients within the healthcare system. In order to achieve this goal, the healthcare organizations should identify the existing barriers ad risks, and assess the level of overall mortality of the population. The second dimension is concerned with the improvement of the overall health of the US population. After finding out all the risks and challenges that communities face, the healthcare organizations should address these issues preventively and pre-emptively, reducing the healthcare cost and providing patient-centered care. The last facet of the Triple Aim model is to reduce the per capita cost of the healthcare provision. According to the statistics, more than 17% of the gross domestic product are the expenses on the health care (“IHI Triple Aim”, n.d.). Although the cost of the medical care is rising annually, its quality is not, unfortunately. While many other countries in the world offer better quality of healthcare for lower costs, the USA fails to do so due to the aging population, longer life expectancy and prevailing number of chronic medical conditions. Therefore, there is a need to implement platforms and models to tackle the issue of the high healthcare expenses.
The IHI represented five main concepts of the Triple Aim framework, which will optimize the US health system: focus on individuals and families, redesign of “primary care” services and structures, prevention and health promotion, cost control platform, and system integration. Within individual healthcare organizations these concepts can be applied through maintaining partnerships with individuals, their families and caregivers; planning and customizing care at the level of the patient; forming a team of professionals for basic services; rewarding healthcare providers for providing better health for the population; developing a system for ongoing learning and improvement. Examples to demonstrate the changes in the healthcare system made due to the Triple Aim model are the implementation of Electronic Health Records, Accountable Care Organizations, bundled payments, patient-centered medical homes and other similar initiatives.
The implementation of the IHI’s Triple Aim model can be challenging and problematic as within this framework it is crucial to maintain the balance between all three goals. It can be the case when the overall health of the community improves but at the expense of the cost, and vice versa. However, the impact made by the Triple Aim model on the overall community health and quality of the medical care can be demonstrated by the example of Primary Care Coalition in Montgomery County, Maryland (“Achieving the IHI Triple Aim: Summaries of Success”, n.d.). This coalition was one among 15 healthcare organizations to acquire the IHI Triple Aim system, and their CEO, Steve Galen, indicated the effectiveness of the system in their organization. By persuading specialists to treat patients for free, encouraging the collaboration between healthcare organizations, government and social service organizations, and expanding capacity of low-cost mammograms to make it easier for women to get them, the Primary Care Coalition was able to move towards a population health focus. In addition, Steven Galen believes that by further implementing the Triple Aim to other organizations in the county, they will be able to reduce the cost of the provided healthcare by 20%, enhancing the health of the population even more. Moreover, according to the study by Farmanova et al. (2017), the Canadian example demonstrates that all three goals can be achieved through the implementation of the IHI Triple Aim model. Although the integration process requires a high level of governance, continuous quality improvement and collaboration between different sectors, the overall success of the Triple Aim framework can be achieved.
One of the innovative delivery models that was introduced as a part of the Triple Aim and concerned with the reduction of the healthcare provision cost via reimbursement is Accountable Care Organizations (ACOs). ACO is groups of different specialists and experts that voluntarily work together in collaboration to provide a patient-centered care and reduce the cost of the medical care. These organizations were implemented to meet the goal of the Triple Aim as well as Quadruple Aim frameworks. The main goal of ACOs is to ensure the provision of quality and cost-effective care to a specific population. In order to meet this goal, a number of experts such as physicians, primary-care providers, hospitals and others create a network, identify the targeted population and assume the risks they face, mitigate those risks and ensure qualified care provision without wasteful and unnecessary expenses. This model was first introduced in the US healthcare system, and rapidly gained popularity among policy-makers from other countries such as Canada and England. In ACOs, healthcare organizations are accountable to patients and payers via a pay-for-performance model, in which medical care providers share their overall savings for a patient, reducing the overall cost of the provided medical care without negatively influencing its quality. In this model, providers focus on the total cost of the patients’ care rather than cost of services. ACOs tie the payments for the healthcare provision directly to its quality and makes providers financially responsible for the expenses that the patients have to make for the treatment. In other words, care providers do not receive payments on a fee-for-service model, i.e. for each service, procedure they provide, but receive money based on their overall performance in delivering health to the population.
Since the ACOs model was first introduced in the USA, it is found to be very effective in addressing the issue of the high healthcare expenses. According to the research by Wilson et al. (2020), the ACOs manage to reduce the cost of the medical care provision across the US without reducing the quality of the care. Moreover, after the ACOs implementation, there was seen a quality improvement in a number of health care organizations. Overall, it was found that most of the organizations that applied the ACO model were more effective in meeting majority of quality indicators and performed better than traditional fee-for-service model.
References
Achieving the IHI Triple Aim: Summaries of success | IHI – Institute for healthcare improvement. (n.d.). Improving Health and Health Care Worldwide | IHI – Institute for Healthcare Improvement. Web.
Farmanova, E., Kirvan, C., Verma, J., Mukerji, G., Akunov, N., Phillips, K., & Samis, S. (2017). Triple Aim in Canada: Developing capacity to lead to better health, care and cost. International Journal for Quality in Health Care, 28(6), 830-837. Web.
The IHI Triple Aim | IHI – Institute for healthcare improvement. (n.d.). Improving Health and Health Care Worldwide | IHI – Institute for Healthcare Improvement. Web.
Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes and costs: A rapid review. Journal of Health Services Research & Policy, 25(2), 130-138. Web.
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