POSTED : September 12, 2016
BY : ProKarma

There are historical indications that the three-legged stool dates back to ancient Byzantium. This type of seating was made popular due to its low cost, ease of portability, lasting construction, and universal appeal.   In healthcare we use the three-legged stool analogy quite frequently.  A shining example would be the Triple Aim™ as defined and developed by the Institute for Healthcare Improvement.

The Triple Aim is usually depicted as a pyramid or triangle; but in this case we could also use a three-legged stool. The three legs of our stool are (1) improving the patient experience of health, (2) enhancing the health of populations, and (3) reducing the per capita cost of healthcare.  These three legs would then support a seating surface that we can call “optimized healthcare!”  Admittedly, there was an urge to use the phrase “sit on this” as a descriptor; but a higher sense of decorum won out.

In the 17th Century, the largely unchanged three-legged stool underwent a transformation.  By joining the three uprights of the stool near the bottom, using three horizontal slats; the stool became significantly stronger and a lesser thickness of wood was required for the legs.  This joined design has pervaded into the modern age, as a sign of higher quality stool construction.

Returning to the Triple Aim, let us look more closely at the stool as originally built. Each leg has its own merits and challenges:

  • Improving the Patient Experience of Health – This includes such things as quality of care, patient satisfaction, and access. This leg relies on both the empowerment of the patient and the collaboration of care team for its strength.
  • Enhancing the Health of Populations – Improvement of the health status of the general population is at the surface of this leg. As we dig deeper, we also see that select populations (demographic, morbidity, or otherwise segmented) are targeted for improvement.
  • Reducing the Per Capita Cost of Healthcare – Financial motivators such as fee for value, bundled outcome payments, and penalties for preventable events make up this leg; which relies on money as a behavioral motivator.

Rather than attempt to paraphrase the approach endorsed within the Triple Aim; it is best to go to the source and share the description of approach as set forth by the IHI:

In most health care settings today, no one is accountable for all three dimensions of the IHI Triple Aim. For the health of our communities, for the health of our school systems, and for the health of all our patients, we need to address all three of the Triple Aim dimensions at the same time.

Because the IHI Triple Aim entails ambitious improvement at all levels of the system, we advocate a systematic approach to change. Based on six phases of pilot testing with over 100 organizations around the world, IHI recommends a change process that includes: identification of target populations; definition of system aims and measures; development of a portfolio of project work that is sufficiently strong to move system-level results and rapid testing and scale up that is adapted to local needs and conditions.

IHI believes that to do this work effectively, it’s important to harness a range of community determinants of health, empower individuals and families, substantially broaden the role and impact of primary care and other community based services, and assure a seamless journey through the whole system of care throughout a person’s life.

In the US environment many areas of health reform can be furthered and strengthened by Triple Aim thinking, including: accountable care organizations (ACOs), bundled payments, and other innovative financing approaches; new models of primary care, such as patient-centered medical homes; sanctions levied for avoidable events, such as hospital readmissions or infections; and the integration of information technology.

It is the very last statement that contains the greatest promise for maximization of the Triple Aim. By harnessing the power of IT; all three legs of the stool become stronger.  Analytics holds the key to being able to effectively create a better three-legged stool.  There are already frameworks on the marketplace that are designed to furnish analysis for any one given leg.  The problem becomes trying to synthesize these differing information sources into a single view.

In order to have trusted information to effect change in all three aspects of the Triple Aim; it is necessary to find an analytics solution that addresses all three Aims. To achieve that goal requires an application that can gather data from a single, trusted, 360-degree view of healthcare.  It also means that all data (clinical quality as well as payer cost) must be extracted, normalized, cleansed, and put into a reliable and trusted data model.

So, have you found your joined three-legged stool yet?