Over the past year we have seen many changes in healthcare at the local, state, and federal level.  From the rise of Specialty Pharmacies, to implementation of some of the clauses of the ACA which have impacted hospitals, to more large scale movements.  Examples of these are the creation of ACO’s and across many states, MCOs, as well as the consolidation of healthcare into ever larger entities.  The impetus for this push remains the same golden aim, the triple aim of healthcare, which was cleverly coined by the Institute for Healthcare Improvement, and is:

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

While the goal of the triple aim of healthcare is a lofty one, it is certainly achievable.  Efforts to improve patient experience have given rise to the healthcare “consumer.”  A way in which healthcare is being prodded to think of those it serves as consumers of healthcare products, and an important movement as healthcare utilization is on the rise, and a growing number of insured individuals now have access to a greater source of providers.  Efforts to respond to this change have included more transparency in pricing, an increased emphasis on customer service, and a whole new push toward patient/consumer centered marketing and follow up.

Though some changes have been made, there is a resilient trend that remains in healthcare, which is for the most part a reactive, rather than proactive industry, and this can cause a major barrier to achieving the triple aim of healthcare.  This is completely understandable considering the number of compliance and regulatory issues, but a reactionary implementation of change needed in healthcare is not what is going to get large organizations to the finish line.

A proactive examination of healthcare and all of its nuances is called for, and a general embracing of patient segment population health management across all aspects of healthcare organizations is one of the only solutions which will offer a chance of success in a market which continues to demand more…..more care for more patient….more preventative care…better population health management…higher quality of outcomes- in an atmosphere of less…less reimbursement…less available providers…less resources.

Organizations who continue to remain reactive, rather than proactive, are quickly falling behind when it comes to both financial viability as well as consumer satisfaction.  While those who are willing to apply creative disruption – completely rethinking models of care, access, and utilization of technological advancements – are beginning to see great rewards in the form of achieving improvement across multiple elements of the triple aim in healthcare.

Unfortunately many organization continue to remain on the reactive hamster wheel.  Waiting for new regulations, payment models, or standards to be released……and then seeing what they need to quickly tweak to bring the care at their facility up to speed.  Again, creative tweaks to an existing broken system will not work.  The answer lies in a paradigmatic shift in how care is provided, marketed, and reimbursed for.  The industry is massive, and regulations are complex, but the smartest organizations have a great understanding of the shifts being made in healthcare, and create innovative pilot projects to explore options to achieve the triple aim of healthcare.

Here are some examples:

CareOregon

• CareSupport yielded savings of $5,000 per member per year for high risk patients through better care coordination
• Implementation of a patient centered medical home in association with safety net clinics improved continuity of care and led to a 7% increase in patients with controlled blood pressure and diabetes
• Median monthly costs were 9% lower for dually eligible patients who received care in new pilot sites vs. traditional care sites

Genesys Health System

• A study by General Motors found that the automaker spent 26% less on health care for enrollees who received services from Genesys physicians vs. other local competitors
• Use of the Emergency Department and Hi-Tech imaging services were lower than state averages for other similar healthcare groups participating in a pay for performance program
• Use of health navigators among the uninsured patients enrolled in county health plans improved behaviors in at-risk patients
  • 53% increase in physical activity
  • 17% quit rate among smokers
  • 90% increase in disease self-management
  • 50% reduction in hospital admissions and emergency department visits

QuadMed

• Worksite wellness programs led to increased participation among employees with 25% achieving health goals which qualified them for incentives
• Worksite clinics have been associated with increasing satisfaction with care for employees which quality of care in QuadMed’s clinics meets or exceeds national benchmarks for employers
• Employee health care costs have increased at a slower pace than for other comparable employers, great news showing that affordability as part of the triple aim of healthcare is achievable

The Consistent Thread in Those Seeing Success Achieving the Triple Aim of Healthcare

• In all of these cases, the organizations were proactive about getting ahead of the healthcare curve, rather than being reactive to mandates. They worked toward achieving better care, better outcomes, and cost reduction well before any of these elements were mandated or tied to reimbursement.  This is what has allowed them to achieve the goals of the Triple Aim in Healthcare
• Each of these organizations thought creatively about care – and put the patient at the center of their thinking – in each example care and/or outreach was provided to patients in a non-traditional way, or in a non-traditional setting which led to high impacts on cost savings, outcomes, and management of health conditions – rather than treatment of an exasperated problem
• Each of these examples carefully selected one area of improvement, or one segment of their patient population to target for improvement, and then worked to identify issues for this particular segment of their patient population, and employed innovative pilots to target improvements

If your organization is not proactively working on creating innovative solutions to achieve the triple aim of healthcare, you run the risk of being one of the organizations who will be left behind, either due to an increase in competition which is innovating, or a decrease in reimbursement because the standards of care and quality of outcomes will continue to increase.  To find out what you can do today to proactively prepare your organization, or to discuss how BHM can help you to create an innovative healthcare pilot project to assist you in achieving the triple aim, contact us at 1-888-831-1171 or email us at results@bhmpc.com