The Triple Aim is vital to our collective health

In 2008, a couple of years before the Affordable Care Act became the law of the land, Donald M. Berwick, MD, and his colleagues at the Institute for Healthcare Improvement (IHI) introduced the Triple Aim concept and set to work on ways to (1) improve population health, (2) increase patient satisfaction and (3) reduce per capita healthcare costs.

In pursuit of these goals, IHI encouraged the exploration of a variety of population health interventions — primary care promotion, enhanced communications between physicians and patients through e-mail correspondence, and targeted education initiatives to promote self-management of chronic conditions to name just a few. But, until recently, the term “population health” prompted questions even among my colleagues at Thomas Jefferson University.

Since “Obamacare” took effect in 2010, fans and foes alike have been struck by how fast we are moving toward the fulfillment of the Triple Aim and the true practice of population-based healthcare.

This movement is prompted, in no small measure, by the law’s call for broader health insurance coverage (i.e., health insurance exchanges), greater connectivity and population-based analytics, improved care coordination, and increased patient engagement.

There is ample evidence that the population health movement has begun to spread beyond the usual cited organizations, incluidng the Kaiser Foundation, the Mayo Clinic, and Geisinger Health System.

Electronic health record (EHR) companies, for instance, are inventing new strategies to facilitate the move to population health management by integrating patient data from disparate health information systems, organizing it for easy clinical access, and delivering it to clinicians at the point of care.

Example: Allscripts has begun to leverage aggregated EHR data, analytics, and patient portal technology to develop tools for clinical decision making and patient self-management.

The company sponsors a Population Health Forum where caregivers from around the country share examples of how population health management is enabling them to improve upon their clinical protocols while dramatically reducing costs.

Retail pharmacy chains are taking more active roles in population health management by applying clinical analytics and predictive modeling to their rich pharmaceutical data.

Example: Recently, Walgreens developed a stratified approach to identify subpopulations of patients who are at risk for “triple fail events” — (1) suboptimal health outcomes that are (2) overly expensive and (3) result in patient dissatisfaction — who could benefit from preventive measures.

In this way, the pharmacy can better determine which subsets of patients are at high risk – for events such as unplanned hospital readmissions within 30 days, untimely nursing home admission, or over-medicalization at the end of life – and direct information and other appropriate resources to patients, their physicians, and their caregivers preventively.

Health care consulting companies are entering the population health arena in new and potentially beneficial ways.

Example: Aegis Health Group recently launched a password-protected online population health portal designed to help employees identify and address their health risks proactively, and to provide employers with aggregate data and analytics for making decisions regarding employee wellness programs and incentives for completing programs.

I am energized by the growing number of organizations that recognize the Triple Aim as vital to our collective health — and I look forward to seeing fewer puzzled expressions when I say that I am the dean of a school of population health.

David B. Nash is founding dean, Jefferson School of Population Health, Thomas Jefferson University and blogs at Nash on Health Policy and Focus on Health Policy.

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