Bending The Cost Curve Of The United States

Triple Aim, as defined by the Institute for Healthcare Improvement, consists of improving patient experience of care, improving health populations, and reducing per capita health care costs simultaneously (IHI, 2009). Triple Aim is not focused on patient satisfaction or on reducing the growth of healthcare; rather it is based on the six Institute of Medicine (IOM) dimensions (safe, effective, patient-centered, timely, efficient, and equitable), reducing per capita healthcare costs, and improving health populations (Relman, 2001). Key to the Triple Aim model is understanding each element works in tandem with each other and sacrificing population health at the expense of reducing per capita expense, for example, does not comply with the Triple Aim

The Triple Aim provides guidance for the creation of strategies to address the suitable delivery of health care services such as, improving patient care coordination and chronic disease management, preventative health, and eliminate the misuse of healthcare services. The fundamental idea with initiating the triple aim is to simultaneously work at all three goals to achieve better patient health and health care systems. According to Bucher & O 'Day (2014), Triple Aim is the answer to optimize health system performance and patient outcomes. An analysis of Triple Aim reveals several difficulties with implementation, the importance of population health, attempts to “bend the cost curve”,

Triple Aim, as defined by the Institute for Healthcare Improvement, consists of improving patient experience of care, improving health populations, and reducing per capita health care costs simultaneously (IHI, 2009). Triple Aim is not focused on patient satisfaction or on reducing the growth of healthcare; rather it is based on the six Institute of Medicine (IOM) dimensions (safe, effective, patient-centered, timely, efficient, and equitable), reducing per capita healthcare costs, and improving health populations (Relman, 2001). Key to the Triple Aim model is understanding each element works in tandem with each other and sacrificing population health at the expense of reducing per capita expense, for example, does not comply with the Triple

The Institute for Healthcare Framework developed the Triple Aim. The framework of this model is an approach for change. Within this framework there are five concepts to focus one when implementing in different organizations. These include: “Focus on individuals and families, Redesign of primary care services and structures, Population health management, Cost control platform and System integration and execution”(Institute for healthcare Improvement, 2016). The goal of the Triple Aim is for organizations to have healthy populations while reducing per capita cost of care.

However, prior to the existence of the ACA, the American healthcare system left a lot to be desired and still today leaves room for improvement. The basic issues underlying efforts to improve the United States (US) health care system remain, as they have for decades, concerns for costs, access, and quality (Sultz, 2006). Even though knowledge, technology, and

​Kaiser Health News recently published an article on a new trend in healthcare. This trend introduces the Accountable Care Organization (ACO). The Centers for Medicare and Medicaid services defines it as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (“Accountable Care Organization,” 2015). According to the Affordable Care Act (ACA), the goal of the ACO is to be able to share health cost-savings with providers who are able to save money by eliminating unnecessary procedures and reduce health costs while increasing quality of care. ACOs make health professionals become more accountable in maintaining good-quality, coordinated healthcare for a patient through a value-based system that is evaluated through a number of criteria and benchmarks (Ronai, 2011).

The Affordable Care Act (ACA) legislated in 2010, has changed the United States health care industry. In addition to universal healthcare, one of the principles of the ACA is the ideal of accountable care. Specifically, adopting an Accountable Care organization (ACO) for Medicare beneficiaries under the fee for service program. An ACO seeks to hold providers and health organizations accountable for not only the quality of health care they provide to a population, but also keeping the cost of care down (1). This is accomplished by offering financial incentives to the healthcare providers that cooperate in, circumventing avoidable tests and procedures. The ACO model, seeks to remove present obstacles to refining the value of care, including a payment system that rewards the volume and intensity of provided services instead of quality and cost performance and commonly held assumptions that more medical care is equivalent to higher quality care (2) .A successful ACO model, will have developed quality clinical work and continual improvement while effectively managing costs, however this is contingent upon its ability to encourage hospitals, physicians, post-acute care facilities, and other providers involved to form connections that aid in coordination of care delivery throughout different settings and groups, and evaluate data on costs and outcomes(3). This establishes the ACO will need to have organizational aptitude to institute an administrative body to manage patient care,

Title three: making the quality and efficiency of health care in US to be of a higher standard. Under this title, the quality of medical care would be enhanced for every U.S citizen, mainly to those who were members of Medicaid and Medicare. A research was set to be conducted aim at mobilizing consumer on taking good care of their health. Accountable Care Organizations would also receive a percentage of the savings

With the passage of the Affordable Care Act (ACA) in 2010 there have been significant changes in the healthcare environment in the United States. The ACA has a goal of increasing access to health care services while also reducing costs. Today’s “triple aim” of healthcare includes improved population health, better patient satisfaction, and lower patient costs.

Since the mid 1990’s, a predominant concept of healthcare is the iron triangle of care, consisting of three competing issues: quality, access, and cost. (Carroll, 2012). William Kissick, who introduced the model, suggested that if you improve one or two of these issues areas, it comes at the expense of the third. If quality of care is increased, it comes at the expense of access or through increased cost. If access to care is improved, it is at the expense of quality or increased cost. If an institution is successful at cost containment while providing care, it is at the expense of quality and/ or access. (Kissick., 1994, p.13). Despite this deeply ingrained concept, the Agency for Healthcare Research and Quality (AHRQ) viewed the use of Health Information Technology (HIT) in the nation’s healthcare delivery as a resource to promote quality and access while potentially decreasing overall cost. (U.S. Department of Health & Human Services, 2003). (Page 175 of Delivering Healthcare in America) In efforts to promote the use of HIT, AHRQ provided five goals of implementation that would best impact the healthcare provided throughout the federal and private healthcare systems. These goals, when applied to the federal

With the continued transformation of the healthcare system, an increased emphasis on consumerism and quality-based reimbursement will be observed. This could lead to challenges for all managed care stakeholders. One example of an industry change that might occur is that patients’ out-of-pocket costs could increase. The cost of healthcare continues to rise faster than inflation, generating increased incentives for insurance companies to offer plans with high deductibles and small networks. In the article “The Top Changes MCOs Should Expect in 2016” Joel Brill (2015) states that:

The fragmented and misaligned state of the U.S. health care system has become a catalyst for payment and delivery system reforms. Traditional fee-for service (FFS) payment structures incentivize high volume rather than high quality care, and lead to the suboptimal provision of medical services across the disjointed provider landscape. Despite various attempts to improve care delivery, health care costs continue to rise. The Accountable Care Organization (ACO) model seeks to reverse these trends by promoting a simultaneous restructure of the payment and delivery systems to incentivize higher quality, lower cost care.

Those goals are the Triple Aim’s “cost, quality, and access”. The Triple Aim components are not independent of each other. Changes pursuing any one goal can affect the other two, sometimes positively or negatively.

The health care industry is one of the most dynamic and delicate industries in the U.S. having experienced healthy and substantial changes for the last thirty years most of which have aimed to improve health care management and services delivery to the patients. The changes have enabled the integration of technology into the industry such as in the area of informatics, science and research and payment services and clinical treatments. The health care sector has introduced various changes to address disease and health care management such as the Modernization Act of 2003, the Patient Protection Act and Affordable Act, which aim at improving health provision and most

The healthcare system has seen significant change over the past decade. This is due to improved technology, healthcare reform, and the economic crisis (Hendren, 2010). With the changes that are occurring,