How Analytics Will Help You Achieve the Triple Aim

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Analytics has been used in healthcare for over a decade — but mostly by the finance team. Now we’re beginning to use analytics to drive performance improvements in healthcare, in specific, to achieve the Triple Aim.

The Triple Aim is not a new concept but it wasn’t until government mandated healthcare reform that the Triple Aim became a sought-after goal for health organizations. That’s where analytics fits in because by using powerful analytics applications, health systems can now use their data to achieve the Triple Aim.

The Three Goals of the Triple Aim

The Triple Aim is a term coined by the Institute for Health Improvement (IHI) and, particularly, one of its founders, Dr. Donald Berwick. IHI defines the Triple Aim as “a framework for optimizing health system performance.” There are three components to the Triple Aim:

  1. Improve the experience of care
  2. Improve the health of populations
  3. Reduce the per capita costs of healthcare

It’s important to point out this framework is called the Triple Aim and not the Triple Aims. Why? Because all three components must be balanced and addressed in order to reach the overarching goal of optimizing our healthcare system. Focusing on just one or two of the elements in the framework isn’t enough to reform healthcare.

Dr. Berwick and the experts at the IHI have been extremely influential in the field of healthcare. As a result of Berwick’s efforts through IHI, many hospitals in the United States have started performance improvement initiatives.

In fact, Berwick’s success with encouraging hospitals improve their processes, prompted President Obama to recruit him in July of 2010 to serve as the Administrator of the Centers for Medicare and Medicaid Services (CMS). Berwick’s role was to implement the new Affordable Care Act (ACA) and kick-start healthcare reform. But because he was appointed to the job through a recess appointment, there was quite a bit of opposition to his re-nomination. Berwick resigned from CMS in December 2011, but his legacy remained: he brought the concept of the Triple Aim to the CMS — and it stuck.

How Healthcare Reform Aligns with the Triple Aim

The Triple Aim concepts continue to be the driving force behind government healthcare policy and funding. If you look at most of the emerging healthcare reform initiatives, you will see how the goals for reform and the goals for the Triple Aim align.

Take for example the ACA. This act illustrates one, very significant, example of how the Triple Aim informs government policy. Although the ACA was enacted three months before Berwick’s appointment, the elements of the Triple Aim are highly aligned with the ACA, which you can see in the following comparison table.

Triple Aim Criteria Initiatives in the Affordable Care Act
Improve the experience of care
  • Offer incentives and penalties to improve the experience of care, such as:
    • Meeting the Value-Based Payment (VBP) patient satisfaction goals and the Consumer Assessment of Healthcare Providers and Services (CAHPS)
    • Supplying patient portals
Improve the health of populations
  • Provide payment based on quality, such as:
    • Achieving quality metrics, and
    • Meeting pay-for-performance/physician quality incentives
  • Establish awards for clinically integrated care, such as,
    • Working Health Information Exchanges
    • Creating disease registries
    • Providing clinician portals
    • Offering Patient Centered Medical Homes
    • Creating and delivering Accountable Care Organizations and Medicare Shared Savings Programs
    • Providing population health initiatives that:
      • Support and encourage patient engagement
      • Incorporate mobile applications for patients achieving health goals
      • Integrate electronic home device monitoring systems and telemedicine
Reduce the per capita cost of healthcare
  • Make adequate health insurance coverage more affordable and available to the public by:
    • Offering incentives to expand coverage
    • Regulating healthcare coverage (including first dollar coverage for preventative care)
    • Creating health insurance exchanges
  • Reform delivery and payment systems to provide better care in a cost-efficient manner by:
    • Imposing employer penalties
    • Structuring payment based on quality

The Role of Analytics in the Triple Aim

Achieving the Triple Aim is a complex endeavor that requires healthcare organizations to understand their past and current performance and to then implement interventions to improve. This entire process requires a strong data foundation and the tools to continuously measure performance. It also requires the ability to combine clinical, financial, administrative, and patient satisfaction data. The best solution to accommodate all of these needs is a healthcare enterprise data warehouse (EDW) platform. Advanced analytics can then run on the platform to enable organizations to perform an almost unlimited range of analysis on the data in their EDW.

Here is a brief overview of how analytics can address the Triple Aim:

1.          Improve the experience of care. Before Value-Based Purchasing, patient satisfaction vendors were vulnerable to financial cutbacks in hospitals. Today, however, health systems are requesting their analytics vendors to integrate the hospital’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores with an EDW, so they can analyze in detail how clinical quality affects patient satisfaction — which in turn, affects financial outcomes.

2.          Improve the health of populations. With the government’s new focus on improving the health of various populations of patients, accountable care, clinically integrated networks, and patient-centered medical homes (PCMHs) are on the rise. These organizations are data-driven, focusing on improving the health of populations. Analytics are required to create population registries, understand gaps in care, stratify populations by risk, and ensure that each member of the population receives the necessary care.

Care management has shifted from acute care-centric to population-centric.

Care management has shifted from acute care-centric to population-centric.

3.          Reduce the per capita costs of healthcare. One of the most effective ways to improve the cost of care is to reduce variability. Variability in the cost and quality of care is, essentially, waste, and it is rampant in the healthcare industry. The Dartmouth Atlas Project has played an important role in drawing the nation’s attention to the wide variability in healthcare quality and costs across hospitals, states, and regions of the United States. What the industry has found is that the most expensive care is not necessarily the best care. Pinpointing variation in the quality and cost of care absolutely requires an analytics system to aggregate and analyze clinical and financial data. Once variation is identified, organizations can decide how best to address it — generally by standardizing best practices across the organization — and can then track improvement over time.

kpa

The Key Process Analysis (KPA) Tool provides data about which areas are using the most resources with the greatest amount of variation.

The Triple Aim is driving healthcare policy in the United States. Achieving the Triple Aim requires a robust analytics system. To survive in our healthcare environment, organizations must get started immediately on implementing analytics.

What is your organization doing to implement analytics?

Which components of the Triple Aim have been most difficult for you to address?

If you enjoyed this article, you might be interested in my article about using Aim statements to measure healthcare quality improvement.

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