Turning the Triple Aim Into Practice

When it comes to transforming healthcare delivery, I’m reminded of Evel Knievel and his fan fared leap over the Snake River Canyon; a jump so big that not even the world’s greatest daredevil could successfully conquer it. But who could really deny the need for improving healthcare? Who could argue against new healthcare policy that champions the ideals of the Triple Aim? The novel attempts to reduce “per capita cost of care”, “improve the patient experience”, and “improve the health of populations” strike right at the heart of America’s healthcare troubles. And yet, in spite of these necessary efforts, the reality of implementing health care changes into actual clinical practice can frequently be far fetched. Here’s why:

Fee For Service is Like an Addiction

Healthcare transformation ultimately comes down to modifying mindsets and behaviors . It means driving cultural change and getting clinicians and other employees within the hospital structure to fundamentally pivot away from a fee for service model; a model widely considered to be the main culprit for healthcare’s skyrocketing costs. Most technological innovation and policy changes occurring in healthcare today serve to push value based care. It is a different payment model that best represents the ideal medium to achieve the Triple Aim and is generally embraced by healthcare advocates and policy makers. Value based models such as Accountable Care Organizations(ACO), Bundled Payment Care Initiatives(BPCI), and most recently, Comprehensive Care for Joint Replacements(CCJR) are launching ambitious goals, with the primary aim to  link 50 % of medicare payments to alternative payment models by 2018 . But one should probably consider the reality of implementing these models and put it into correct context. First, imagine a hospital, whose entire structure at the administrative, clinical, and financial level, operating a certain way under a fee for service model for 20+ years. Then, imagine this hospital embarking on a monumental crusade to quickly change their practice to value based care while taking into account new benchmarks and penalties. This doesn’t just mean adopting a new payment model. It means transforming how providers practice, altering how they treat their patients, and changing how administrators  schedule, and coordinate care. This is clearly more than just adopting a new ideology or implementing policy.

The Silo Effect

Dr. Keefe’s post on Silos and Tribes summarizes it well when she says “many healthcare related communication issues and misunderstandings arise from stakeholders speaking and acting from isolated positions.” One of the unintentional effects of an outdated FFS payment model has been the creation of healthcare silos that may not necessarily align with the mission and values of the hospital in which it resides. Undeniably, the existence of these silos stem from an effort to stay organized and focused. But in doing so, clinicians can lose sight of the big picture, especially when it comes to treating the patient. It’s very interesting to me that many clinicians that work in hospitals can be unaware of the impending changes that are happening to their profession and are having a direct effect on how they practice. Perhaps this could be due to a silo effect, where clinicians that work in a certain department, say an outpatient clinic or skilled nursing facility, are so focused on their specific specialty that they neglect what happens in between. This subsequently can lead to treating the patient from an isolated standpoint instead of treating the patient from a perioperative view. And at a point where transitions to value based care are occurring at a rapid rate, communication barriers that exist within these silos, if not addressed may render adoption of these new payment models ineffective.

Clinicians Still Need a Win

There is no question that the efforts to achieve the Triple Aim are positive and necessary. But I argue that none of these healthcare policies or technological innovations will mean anything if you don’t get buy in from the clinician. As I mentioned earlier, it’s surprising that many clinicians are unaware of the healthcare changes occurring. And it makes me wonder if hospitals are doing enough to educate their staff on what’s coming and providing enough resources and support to help these clinicians adapt to new payment models. I think it’s safe to say that a clinician’s workflow, regardless of practice, is already bombarded with a full caseload in addition to the ongoing documentation burdens that already exist. And now, by transitioning to value based care, clinicians are essentially being asked to modify how they treat and practice.

Amidst all the healthcare innovation and policy changes happening, the successful implementation of a new kind of healthcare ultimately boils down to improving the patient’s experience. Achieving the Triple Aim has to be done in such a way it creates an environment that fosters a strong connection between the patient and clinician.

by Ben Torres