This blog post is the fifth in the Supply, Demand and Medicine series on health care reform.
What patients want most out of any health care experience is a good outcome at a reasonable cost. That’s also what your health care provider wants out of each and every patient encounter. But transforming the way health care is delivered in the United States is about much more than a singular patient encounter.
To deliver great care at a reasonable cost on an individual level, means making sure the entire health system is running as optimally as possible.
Fortunately, a framework has existed since 2008 to achieve this monumental task: the Institute for Healthcare Improvement’s “Triple Aim” for health care.
If you want to understand the goals of health care reform from a health care provider’s perspective, the Triple Aim is a great place to start.
Aim 1: Improving the patient experience of care
This first aim is perhaps the most personal and vital from a patient’s perspective. It encompasses both quality of care and the level of service with which it is provided.
While different hospitals and health systems may take slightly different approaches to achieving this first aim, at Baylor, its all about providing STEEEP care.
That is, health care which is safe, timely, effective, efficient, equitable and patient-centered.
These are the six domains that make for a great care experience. It’s why STEEEP care has been a cornerstone at Baylor long before the Triple Aim was introduced.
Some tangible results from achieving this first aim (or STEEEP care) are seen in reduced complications, fewer infections in the hospital or as the result of surgery, and care that is provided with the speed necessary to prevent a patient’s condition from worsening and expedite healing.
Aim 2: Improving the health of populations
Improving the health of an entire community, city, region or country is a complex issue that has societal elements and individual elements. It involves not only patients, physicians and other health care providers, but has political, cultural and business elements as well.
At its most fundamental, though, this aim is about providing incentives and options so that people choose to be healthy.
For instance, whether or not someone smokes is a personal choice. However, we as health care providers must provide the tools necessary to help smokers quit both as inexpensively and conveniently as possible.
It also is incumbent upon physicians and other providers to make sure all the patients under their care are taking steps shown to improve health and prevent disease.
HealthTexas Provider Network (HTPN), Baylor Health Care System’s employed physician group, has been able to improve the health of tens of thousands of patients under their care by focusing on patient education and writing orders shown to improve health.
The results have been remarkable:
- An adult immunization rate improving from 39 percent to 95 percent
- A colorectal screening rate increase of about 50 percent
- Going from 55 percent of patients with high blood pressure on controller medications to 78 percent.
HTPN was able to accomplish this by closely tracking many different aspects of their patient population’s health. When reviewing patient records, if something was missed (e.g., a patient with high blood pressure not on medication), HTPN could contact the patient to correct it.
Aim 3: Reducing the per capita cost of health care
As with any industry, there are many ways to go about reducing costs – some more appealing than others. Eliminating waste and inefficiencies is the best solution because it actually improves, rather than sacrifices, quality.
Waste is an enormous cost driver in health care, and a key reason why the United States spends more on health care per capita than any other country, without better outcomes to show for it.
According to Donald Berwick, MD, former Administrator of the Centers for Medicare and Medicaid Services, 20-30 percent of health care spending is waste. Waste can take the form of too much care, too little care or wrong care.
Please see my previous post on this topic for more on reducing health care costs by eliminating waste.
In addition to waste, simply keeping health care providers informed of efficiency metrics helps promote cost containment.
For example, Baylor Quality Alliance, which includes more than 2,400 physicians, produces a regular report for each physician containing cost variation information and their performance on efficiency metrics such as prescribing generic, instead of brand name, medications.
Generic prescribing has helped save HTPN patients and the health care system millions of dollars without sacrificing quality.
Ultimately, that’s everyone’s goal and the concept behind the Triple Aim: to reduce costs, not quality.