Triple Aim

There is clearly something wrong with America’s healthcare system. The three numbers that get thrown around the most, which seem to unequivocally prove how broken our system is, are 17.3%, 37th and 1st.

These numbers are open to debate and criticism, because of their respective methodologies, but even if they’re all off by 20%, we still have a giant problem.

I recently attended the HIMSS Texas Regional conference in Dallas. The recurring theme was how we can improve healthcare. One approach, which came up in a few sessions, was the “Triple Aim.” Originally developed by the Institute for Healthcare Improvement, the Triple Aim is described as:

…an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”

While the Triple Aim seems to be generally targeted at helping health systems to optimize delivery, there is value for everyone in the healthcare space to take a step back and refocus on what we’re trying to do. It serves as a reminder that progress in healthcare doesn’t have to involve new advanced procedures, ‘big data’, complex analytics, or high level policy changes as long as positive incremental changes are being made. You can’t make a rule out of it, but generally the right kinds of positive changes to any one of the aims will positively affect the other two. For example, it has been repeatedly demonstrated that when the patient has a better experience, the outcomes are likely to be improved and he will require less care from costly providers. A source of lost value in health care stems from non-adherence to care plans. Data show improved patient experience translates to improved adherence.

…the quality of the patient-doctor relationship is a very important determinant of regimen adherence. Research has demonstrated that patients who are satisfied with their relationship with their health care providers have better adherence to diabetes regimens. In addition, patients who have a “dismissing attachment” style (discomfort trusting others [negative view of others] and therefore greater self-reliance [positive view of self]) toward their doctor and who rate their patient-provider communication as poor have been shown to have lower adherence rates…

Improving Patient Adherence, Alan M. Delamater, PhD, ABPP. American Diabetes Association

Enhancing the patient experience is simpler than it seems. There are already tools in the doctor’s office not being utilized that increase the patient experience, like…a chair. When a physician sits down during a patient encounter, the patient perceives that the doctor spends 40% more time with him or her than if the doctor was standing.

When patients think the doctor is in the room longer, they express a better understanding of their condition and greater satisfaction with their care, which can be factors in decreased lengths of stay, decreased costs, improved clinical outcomes and decreased litigation.

University of Kansas study

That perception can translate into real value. The better a patient understands their condition the more likely they are to adhere to their care plan. In addition, the simple act of sitting can increase patient satisfaction and adherence in spite of things like short appointments and lack of relevant or audience appropriate educational material.

We develop software, which is admittedly more complicated than making (or sitting in) a chair, but these studies very much embody a philosophy we have at Visible Health - a good innovation doesn’t have to be big or complicated to advance the triple aim. It does, however, have to be relevant, adoptable, usable, and meet a need of the patient or their care providers. Let’s remember, small solutions for real problems can have a big impact.