The United States ranks far behind other countries in providing high-quality healthcare at a lower cost, partly due to an increasingly aging population and more chronic disease management. As a solution, the Institute for Healthcare Improvement developed a framework known as the Triple Aim in 2007, with an overall goal of maximizing health system performance. The Triple Aim consists of population health, patient experience, and reduced per capita costs. This approach includes improving the health of the community, with a focus on what’s important to the patient, while optimizing healthcare performance.
Population health is a concept that broadens reach into the community, identifying and addressing health problems before they reach the healthcare system. Because people in the community often become patients, understanding their health needs can help organizations develop programs to improve care and reduce costs. Genesys health system in Flint Michigan developed a triple aim system that included a navigator role as part of a primary care team to act as a liaison for patients and the healthcare team. This community has had significant challenges with chronic unemployment within a complex economic and social background. The following example represents the Triple Aim in action:
A 39- year-old, low- income and uninsured male with a 6-year history of hypertension was assessed by a Health Navigator following a hospital admission. Unable to work due to his high blood pressure, the patient had stopped following his treatment plan due to the high cost of his prescription medications. In addition, the patient smoked, did not exercise, and ate an unhealthy diet. After receiving self-management support through the Healthworks model, the patient experienced improved care for his hypertension, and adopted healthy behaviors including increasing his physical activity, improved diet, and smoking cessation. These changes are leading to a decreased need for high-cost acute care via hospital admissions and emergency room visits. (Institute for Healthcare Improvement, n.d., p. 2)
This example demonstrates how helping people in the community become healthier benefits patients and reduces healthcare costs, representing an effort to improve the overall health system.
The prenatal centering pregnancy program is another example of integrating the triple aim approach for the pregnant patient population. It incorporates risk assessment, education, and group support into prenatal care. Pregnant women regularly participate in group discussions with their health care providers on stress management, labor, and nutrition. In addition, they actively participate in their care by measuring weight and blood pressure and recording their data. Evidence from group prenatal care models is promising, with a small number of studies demonstrating “…reductions in preterm birth and neonatal intensive care unit (NICU) admissions; increased birth weight for term and preterm infants; increased rates of breastfeeding initiation and continuation; decreased emergency department visits in the third trimester; improved pregnancy-related weight management; an increase in patients presenting in active labor and at greater cervical dilatation; increased patient and obstetrician and other obstetric care provider satisfaction; and improved knowledge of childbirth, family planning, postpartum depression, and early child-rearing” (American College of Obstetricians and Gynecologists, 2018, p.e105).
Lastly, patient experience includes a variety of interactions that patients have with the health care system, including their experience with health care insurance and staff in healthcare facilities. Everyone who comes in contact with the patient can impact this, from the environmental staff cleaning the room to the surgeon performing the procedure. Patient experience also includes other features of healthcare delivery that are important to patients such as ease and timeliness of appointments and good communication with health care providers. It can be gathered through surveys such as the Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and the Agency for Healthcare Research and Quality (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Surveys allow a way to hear about what’s important to the patient. Another benefit of surveys is that they capture themes- if patients are reporting the same thing over and over, it’s hard to dismiss that, in comparison to feedback that may be heard from one person. Taking the information from surveys enables providers to adjust their care to meet the needs of the patient. In summary, the Triple Aim is an approach to optimizing health system performance in a way that is patient-centered and cost-effective.
American College of Obstetricians and Gynecologists. (2018). Group Prenatal Care. ACOG Committee Opinion No. 731. Obstet Gynecol; 131:e104-8. Retrieved from https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2018/03/group-prenatal-care.pdf
Achieving the IHI Triple Aim: Summaries of Success: IHI. (n.d.). Retrieved from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/ImprovementStories.aspx
The IHI Triple Aim: IHI. (n.d.). Retrieved from http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx
Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington Manual of patient safety and quality improvement. Wolters Kluwer.
Institute for Healthcare Improvement. (n.d.) Genesys HealthWorks Integrates Primary Care with Health Navigator to Improve Health, Reduce Costs. Retrieved from http://www.ihi.org/Engage/Initiatives/TripleAim/Documents/IHITripleAimGenesysHealthSystemSummaryofSuccessJul09v2.pdf
Kilpatrick, S. J., Papile, L., Macones, G. A., & Watterberg, K. L. (2017). Guidelines for perinatal care. American Academy of Pediatrics.
What Is Patient Experience? (n.d.). Retrieved from
Why Use a CAHPS Survey To Assess Patient Experience? (n.d.). Retrieved from https://www.ahrq.gov/cahps/news-and-events/podcasts/ginsberg-podcast.html