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The Triple Aim

The Triple Aim. Review of TA 101: Introduction to the Triple Aim for Populations. Lecture Objectives. Describe the three components of the IHI Triple Aim for populations.

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The Triple Aim

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  1. The Triple Aim Review of TA 101: Introduction to the Triple Aim for Populations

  2. Lecture Objectives • Describe the three components of the IHI Triple Aim for populations. • Explain the responsibilities of clinicians and health care systems in optimizing population-level outcomes with available resources. • Discuss the role of safe, high-quality medical care in population health. • Provide examples of population-level interventions designed to improve overall health and reduce costs of care.

  3. Lecture Outline • Improving population health • Providing better care • Lowering costs of care

  4. ‘Population Health’ • “The health outcomes of a group of individuals, including the distribution of such outcomes within the group” • Dr. David Kindig and Greg Stoddart

  5. What groups are you a part of? • “The health outcomes of a group of individuals, including the distribution of such outcomes within the group” • Dr. David Kindig and Greg Stoddart

  6. Examples of Groups • Geographic groups • Professional groups • Racial/ethnic groups • Special interest groups • Special needs groups • Etc.

  7. How does being a member of certain groups influence your health? • Geographic groups • Professional groups • Racial/ethnic groups • Special interest groups • Special needs groups • Etc.

  8. Example: Geography Matters • Do you have easy access to healthy food? • Is your neighborhood free of crime? • Is it safe to walk around where you live? • Do you have access to green spaces? • Do you have access to good schools? • Cycle of access in the US: • Access to quality education early in life influences access to higher education, which influences access to jobs, which influences access to quality neighborhoods, which influences access to childhood education…

  9. How much does each factor influence health? • Clinical care • Social/economic factors • Environmental • Health behaviors ?

  10. Determinants of Health

  11. Clinical Care is “The Tip of the Iceberg”

  12. ‘Upstream Factors’: 50 Percent • Income and wealth • Education • Employment and occupation • Family and social support • The built environment • The food environment • Community safety and culture • Media/information environment • Environmental pollution • Individual factors: genetics, resilience, spirituality

  13. Model of Population Health Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.

  14. The Cost of Disparities • The US economy loses an estimated $309 billion annually due to the direct and indirect costs of groups of people not receiving the same treatments or benefiting from the same health outcomes as others. • An estimated 30 percent of direct medical costs for African Americans, Hispanics, and Asian Americans could be attributed to health disparities. LaVeist TA, Gaskin DJ, Richard P. The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies; September 2009. http://hsrc.himmelfarb.gwu.edu/sphhs_policy_facpubs/225/

  15. Providing High-Value Care • You can improve value by either increasing quality or decreasing costs. • Population management • Resource stewardship • If we saved wasted money, we could use it to improve services and health.

  16. Population Management • Reducing waste by improving services for groups of patients • Shift in focus from care provided and paid for at an individual level to managing and paying for health care for defined groups, i.e., populations

  17. ‘Upstreamists’ in Health Care • Systematically understand and address social determinants of health • Consider where people live, work, and play • Improve workflows of clinical medicine and social services

  18. Moving ‘Upstream’ — Examples • Thinking holistically about patient health needs • Physical • Mental • Spiritual • Social • Considering care for groups of patients • Referring patients to community resources • Evaluating costs of care and seeking to improve value • Engaging patients and families • Forming community partnerships

  19. Video https://youtu.be/Kn5xyct4Hd0 http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Jason-Leitch-What-If-You-Take-a-Complex-Clinical-Challenge-to-the-Community.aspx

  20. Discussion • What were some of the factors affecting stillbirth rates that you heard in the video? Why couldn't obstetricians solve the problem on their own? • Do you think it would be hard to convince staff and patients to participate in multidisciplinary rounds after a stillbirth? Why might people resist this, and how might you address their concerns? • What other health care problems might be improved by addressing factors outside of health care, for example, living conditions? http://www.ihi.org/education/IHIOpenSchool/resources/Documents/Facilitator_Leitch_ComplexChallenge.pdf

  21. Exercise • Go to http://www.countyhealthrankings.org/ • Pick a county to explore: Find out how healthy it is, and explore factors that drive health in that area. • Discuss what you learned, referring to the discussion questions athttp://www.ihi.org/education/IHIOpenSchool/resources/Documents/TA101_exercise.pdf

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