Triple Aim Is Triply Tough:

Abstract

A ccording to leading health care experts, the US health care system needs to address the triple aim of improving the patient experience of care, the health of populations, and reducing unnecessary costs.1 Several value-based payment models are underway, including the development of Next Generation Accountable Care Organizations (ACOs), alternative payment models and merit-based incentive programs (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA). 2,3These programs specifically include quality, cost, and patient experience and are directly impacted by primary care. These models currently target practicing clinicians; however, it is necessary to train future primary care physicians so that they are prepared to meet triple aim goals in their future practices. In response to this, faculty development initiatives are examining the transformation of primary care residency training and the clinical practice setting. 4,5With the changing landscape of primary care delivery, knowledge, and skills in assessing and impacting population health management, improving processes of care in practice settings and managing change are critical for physicians. The necessary process of measuring and improving quality in academic medical center environments, however, can prove challenging given academia's tripartite mission of research, teaching, and patient care. BACKGROUND AND OBJECTIVES: The I3 POP Collaborative sought to improve health of patients attending North Carolina, South Carolina, and Virginia primary care teaching practices using the triple aim framework of better quality, appropriate utilization, and enhanced patient experience. We examined change in triple aim measures over 3 years, and identified correlates of improvement.

The Relationship Between Patient Satisfaction and Healthcare Expenditures in Adults with Spine Related Disorders

“…Patient satisfaction is also increasingly incorporated into policies and payment models which may influence provider behavior 10 . Fueled by the Affordable Care Act (ACA) and the Centers for Medicare and Medicaid Services (CMS), combining patient satisfaction and quality of care/outcome metrics to reduce costs is now commonplace 10 ; however the ability to optimize each of these coexisting metrics simultaneously (patient satisfaction, quality/outcomes of care, and costs) appears challenging 8,10,34 . Future studies should explore the impact of healthcare systems on patient satisfaction in those with SRDs and monitor associated costs.…”

“…10 Fueled by the Affordable Care Act (ACA) and the Centers for Medicare and Medicaid Services (CMS), combining patient satisfaction and quality of care/outcome metrics to reduce costs is now commonplace 10 ; however the ability to optimize each of these coexisting metrics simultaneously (patient satisfaction, quality/outcomes of care, and costs) appears challenging. 8,10,34 Future studies should explore the impact of healthcare systems on patient satisfaction in those with SRDs and monitor associated costs. Future studies should also focus on identifying why comorbidities and health status in adults with SRDs explain the relationship between patient satisfaction and healthcare expenditures, and how this may be incorporated into interventions to improve healthcare for adults with SRD.…”

The Triple Aim Quality Improvement Gold Standard Illustrated as Extremely Premature Infant Care

“…There is no implied assumption nor statistical documentation that relative position or movement along one axis is similar, better, or worse, to equal position or movement on another axis, which reflects the arguable priorities inherent to the TA concept as a QI gold standard. 1,2,[5][6][7][8][9] To illustrate whether objective QI progress occurred, we also calculated the TA benchmark in Year 2014 versus Year 2019 for each NICU separately, and the whole-group Pod. Comparator spheres were positioned in the three-axis cube connected by an arrowed line pointing from Year 2014 to Year 2019.…”

“…Despite extensive documentation of broad efforts and expenditures, no QI collaboration to our knowledge has demonstrated a sustained, improving TA using relevant surrogate measures of population health, cost, and individual care. [5][6][7][8][9] In fact, vital population health markers are worsening, per capita cost continues to increase in every healthcare specialty, and better individual care progress is inconsistent at best. [10][11][12][13] The care of extremely premature infants born between 23 and 27 weeks' gestation exemplifies the TA paradox.…”

The Practice Is the Curriculum

“…15 However, later iterations found that gains towards the triple aim and valuebased care remain challenged by the strain to accomplish success across multiple domains simultaneously. 16 Lastly, a Colorado initiative centered on transforming 10 residency practices into PCMHs through coaching and redesign. This work led to increased engagement, team-based care, and continuity with patients.…”