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Articulating the “Triple Aim”

May 22, 2012
by Mark Hagland
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Leaders at the Institute for Healthcare Improvement unveil a new book, and discuss their current initiative
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Earlier this month, leaders at the Cambridge, Mass.-based Institute for Healthcare Improvement held a media briefing to announce the publication of a new book, The Triple Aim: Seven Innovators Show the way to Better Care, Better Health, and Lower Costs, co-authored by IHI president and CEO Maureen Bisognano and noted healthcare journalist Charles Kenney. The book describes the advances that clinician and executive leaders at seven different patient care organizations are doing to pursue what IHI calls “the triple aim”—improving patient care, improving the health of populations, and reducing healthcare costs.

On May 5, Bisognano, Kenney, and leaders of the organizations working to live out the “triple aim” creed spoke with journalists in a telephonic media briefing. As Bisognano explained to the journalists gathered on that date, “Charlie and I got together to write this book, because we’ve been observing some of the problems in the healthcare system, and IHI’s mission is to improve healthcare worldwide. We’re spending over $2.7 trillion a year on healthcare, and about 70 percent of that is being spent on chronic illness,” Bisognano noted at the start of her comments.

“And the question we had at IHI was, would investment in certain methods improve health? So we created the IHI Triple Aim to improve the health of the population, improve the experience of care, and to try to improve per capita costs,” Bisognano continued. “We began about three years ago, and as the political rancor has ratcheted up, we started to tour some of these leader organizations, and found that they were ramping up without any prodding from the federal government. So we found that healthcare improvement can develop from the ground up.”

Kenney, who has authored or co-authored other healthcare books, including on innovations taking place at the Kaiser Permanente integrated health system and Virginia Mason Medical Center in Seattle, said that “One of the things for me that is so powerful and comes out in the book is this incredibly dynamic healthcare movement. And Maureen’s point about this not being top-down and government-driven is very important,” he added. In fact, he said, whatever the direction of the healthcare political debate taking place at the federal policy level, he said, “As immensely difficult and challenging as some of the problems are that are facing the healthcare system, there is this sort of organic, grassroots movement underway, and there’s no stopping that movement.”

All of the executives present, representing the Permanente Foundation (Oakland, Calif.), Bellin Health (a two-hospital integrated health system based in Green Bay, Wis.), Atrius Health (a Boston-based alliance of six community-based medical groups serving one million patients throughout Massachusetts), and Mount Auburn Hospitals (a 191-bed hospital in Cambridge, Mass.), agreed that a large number of process and strategic issues were involved in moving forward in all these areas. In response to a question from the assembled press regarding the role of IT in achieving some of the goals outlined in the book, Jack Cochran, M.D., executive director of the Permanente Foundation, said, “The EHR does not come with an owner’s manual on transforming healthcare. So you have to ask new questions. How can you solve people’s problems through connectivity, through information, through team-monitoring? The old physician-centric model won’t endure; it’s not possible for physicians to manage the complexity of information by themselves,” Cochran emphasized. “So we have to take the information and sort out individual patients, populations of populations, through information, sorting knowledge. Getting it in place is just the starting line.”

Richard Lopez, M.D., chief medical officer of Atrius Health, agreed. “Without IT,” he said, “we can’t measure and understand the variation in practices. So deep measurement capability, reporting capability, along with transparency, is probably another essential aspect of IT.”

When asked about getting physicians to buy into data-driven performance improvement processes, Lopez said, “You’re absolutely right, doctors always question the data; that’s the first thing they raise when confronted with their own performance compared to others’. So it is really important to make sure your data is as accurate as possible. But if you develop a culture where your data is not presented in a punitive way, if you develop that culture with the right physician leadership, it can go a long way to getting people to accept the data.”

Meanwhile, at Bellin Health, said George Kerwin, the health system’s CEO, “In Wisconsin, about four or five years ago was created the Wisconsin Collaborative on Health Care Quality, and the whole purpose was to have clinicians, physicians in particular, define quality, and then create measures and share data across the state. So that’s been very powerful to have physicians define quality,” Kerwin said, adding that “Once the measures are created and data begins to flow, physicians are very interested in improving quality. But that collaboration has been very powerful here.”

In the end, said IHI’s Bisognano, speaking of the leaders of all the patient care organizations participating in the “Triple Aim” work being discussed, “The common thread among these visionary leaders is that they’ve seen that they have a responsibility for their community. How does their healthcare system contribute to the community as a whole?” The lessons to be learned going forward will be many, and cumulative, she added.