Triple Aim, doctor and patient talking

Healthcare and The Triple Aim Quandary

The Triple Aim quandary… How many times have you heard the phrase “you get what you pay for?” Maybe you found a seemingly great product or service at a good price, only to be disappointed. Then, while recounting the story to a friend, they lay that old cliché on you. It is frustrating, to say the least.

Quality and excellent experiences do not always have to come at an extreme cost. Look at the way Amazon built its empire. They created a model that combines great customer experience with lower prices and built a retail system that is efficient and profitable. The healthcare industry has been trying to create a similar success story. Known as the Triple Aim, the Institute for Healthcare Improvement’s goals are to:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

Yes, it looks like a pretty tall order but if Jeff Besos can do it to a complex retail structure, why not the healthcare industry? Currently, it hasn’t been done. Providers are working to improve patient experience and the health of their populations through new systems, models and technology but lowering costs has been elusive in large part because providing the former, is widely thought to affect the latter.

The cost of medications is a big issue in achieving the Triple Aim. Patients with chronic diseases do very well when they are taking their medications on a continuous basis but when affordability of medicines comes into play and patients aren’t regularly taking their meds or taking them at all, their health deteriorates. Furthermore, “these rapidly escalating costs for drugs are disheartening when one considers that medication compliance has been shown to help reduce overall healthcare costs in the long-run—particularly in the management of chronic disease.” according to this report.

So, is improved patient experience and better population health just more expensive? Is there nothing we can do? Is achieving the Triple Aim just not possible?

The short answer is no. Care management models and efforts must change to better take care of patients on the frontend. Health plans need to focus on managed care and preventative measures. It may appear that doing so increases costs but when you look at the whole system, it can actually lower cost on a whole. If care managers are checking in with patients regularly, smaller issues can be addressed and not allowed to snowball into larger and more expensive care episodes. As written about before on this site, in-home care can help ease costs as well eliminate certain overhead and administrative costs.

Perhaps the reason the Triple Aim has not been successful is that the healthcare industry has failed to reframe their perspective. Like with many other industries, success is built around a customer or in this case, patient-focused model. Many successful companies have realized this long ago but healthcare is just catching on. It might be worth pushing forward at a quicker pace.

The Triple Aim is a worthy goal and likely there is no “one size fits all” solution. Every healthcare provider needs to look at their systems and processes to create a roadmap for success and adjust their long-term strategies.

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Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

Related: Process Improvement