Seven years after the Institute for Healthcare Improvement (IHI) first developed the Triple Aim, a new report details what the IHI has learned from healthcare stakeholders' efforts to improve individual care, boost the health of populations and reduce overall costs.
The Triple Aim has "had an influence beyond our wildest dreams" since IHI researchers coined the term in 2008, John W. Whittington, lead author of the report, said in an announcement. It is now a core component of the Affordable Care Act's healthcare reform efforts, which in turn have informed the industry's transition to value-based care.
To help other organizations achieve the Triple Aim, the IHI identified the following guiding principles based on its work with 141 organizations, including health systems, hospitals, insurance companies, public health agencies, social service groups and community collations:
- Create the right foundation for population management. To do this, organizations must identify a relevant population; create or identify a governance structure composed of individuals with the power to drive and champion the Triple Aim goals; and articulate a specific purpose around which stakeholders can rally.
- Manage services at scale for the population. Once organizations have identified a population, they need to segment this population into subpopulations with similar needs; conduct an assessment of those populations' needs and assets; develop a portfolio of projects to meet those needs; design or redesign services as needed; develop a plan for delivering these services at scale; and finally, expand the capabilities of "integrator" organizations, such as community groups that want to volunteer their time.
- Establish a learning system to drive and sustain the work over time. The key to successful Triple Aim initiatives is to make them last, and to do so organizations should implement population-level measures such as health outcomes and disease burden; develop an explicit rationale for system changes; learn by iterative testing (or start initiatives on a small scale and build outward); use individual cases--such as an emergency department super-user--to identify broader needs; and select leaders to manage and oversee the learning system.
Though many groups have successfully implemented the Triple Aim among enrolled populations, or a group that belongs to one health plan or visits one health system, executing all three goals on a community level "will continue to be a challenge," the report notes. Other experts, meanwhile, have argued that healthcare should expand the Triple Aim to the Quadruple Aim by adding a fourth component that focuses on caregivers' wellbeing.
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