Even before its formal development by the Institute for Healthcare Improvement (IHI), health care goals have always had three dimensions. The Triple Aim Initiative just gave the industry a framework to pursue them. Improving patient experiences, enhancing population health and reducing costs are the three components of the initiative. They are all equally important and intertwined.
For organizations attempting to reach these goals, there are countless challenges. The US has the costliest health care system in the world, so the pressure to meet the Triple Aim is substantial. It’s even more urgent considering the cracks exposed by the pandemic. Experts remarked that the system was already flawed, but the pandemic brought those failings to the surface.
These cracks and a perfect storm of decreasing patient engagement, eroding trust in the system and the possibility of the next health care crisis point to the criticality of embracing the Triple Aim. Medicare and Medicaid plans need to accelerate their efforts to reach these goals.
Let’s dive into the fundamentals of the Triple Aim initiative that plans need to know:
The history of Triple Aim
The Triple Aim framework dates back to 2008. It began as a lofty endeavor to reimagine health care delivery, the patient experience and cost control. By 2020, it had become a key part of the country’s strategy, particularly in the Affordable Care Act.
In the Triple Aim health care triangle, all three areas carry equal importance. They aren’t steps that lead from one to another; rather, they are inextricably linked. There are steps you can take to support the pursuit, however. Those include:
- Determining a community's unique needs and identifying the most at-risk members due to demographics, conditions and social determinants of health (SDOH).
- Understanding the assets required to meet a community’s needs, which may include creating new services or revising existing ones.
- Creating specific goals for the population in these three areas: patient experience, population health and costs.
- Developing a way to measure, track and illustrate progress.
The question is, are these goals for providers? Plans? Other stakeholders? The answer is that these are for everyone, and everyone must work together.
Triple Aim from the plan perspective
Providers don’t shoulder the burden of Triple Aim. Plans can support providers and their members to achieve the mutually beneficial goal of better care delivered across populations for lower costs.
These are the fundamentals that plans, specifically Medicare and Medicaid, can follow to work toward their Triple Aim goals:
Improving the patient experience
Experience has a lot to do with engagement. If members lack engagement with your plan, then their experiences will not be meaningful or impact their health outcomes.
There are many member engagement challenges for Medicare and Medicaid plans.
It’s critical to look at experience and engagement together because they are very dependent on one another.
You can enhance the member experience by making it easier to navigate benefits and resources. That includes consistent communication across channels to drive awareness of what’s available. However, these actions don't always move the needle on engagement.
With technology, proactive outreach and programs, plans can improve both experiences and engagement. Members are much more inclined to interact with personalized content, making it more likely that they will be satisfied with their experience and have better outcomes. Truly personalized content and interactions go beyond “insert member name here” or lumping a category of members together. It requires understanding member needs and being specific about those in communications.
Reducing costs
A tremendous amount of waste happens in health care spending. If things were expensive pre-pandemic, they are now off the charts. Data shows that expenditures soared in 2020. It’s only natural that a pandemic would drive up costs due to testing, vaccinations and other emergency needs.
However, the most unfortunate part of this higher spending is that quality didn’t improve. Again, this was exacerbated by the pandemic, as the health care industry suffered provider losses, both from burnout and being one of the leading groups to succumb to the virus.
So is there any hope for reigning in costs? Yes, but reducing health care delivery costs requires engaged members who:
- Adhere to their medications and therapies.
- Follow treatment plans.
- Visit their providers regularly.
- Participate in plan programs to live healthier lifestyles.
- Receive annual screens or checks to catch diseases early.
When your members aren’t engaged, they won’t go down the road of preventative care. Instead, they will end up in emergency departments and hospitals — the most expensive places to receive care.
Improving population health
As a Medicare or Medicaid plan, your members are often in at-risk groups. In the case of Medicare, members are seniors and thus have more health problems. For Medicaid and Medicare, SDOH often make it harder for individuals to participate and prioritize their health. Constant worry and stress over the basics often put health issues on the back burner.
A blanket approach to your general membership is less effective than segmenting. By segmenting your members into groups and identifying specific risks they all have in common, you can support patient-centered care and continuity of care. The IHI’s recommendations for this still hold true:
- Involve individuals and families in developing care models.
- Redesign primary care services and structures.
- Improve disease prevention and health promotion (e.g., create targeted communications about accessible options for at-risk communities).
- Build a cost-control platform.
- Integrate a robust support system.
In looking back at these three goals, what's the commonality? Engagement.
Engagement: The common thread
The three parts of the framework are interconnected, and they have a common thread — the need for member engagement. Without it, Triple Aim goals are impossible to achieve. When considering the fundamentals of engagement beyond the standard ploys like communication and programs, you may be overlooking a key driver of disengagement — chronic loneliness.
Loneliness is becoming a big topic in health care. If left untreated, it destroys the member experience, increases costs and impacts community health. It also erodes engagement, which influences how members use care and that has a direct connection to experiences and costs.
Thankfully, there are intervention treatments available that combine technology and human connection. Learn how you can address loneliness in vulnerable populations to achieve your Triple Aim goals.
