A new healthcare framework—the Quadruple Aim—seeks to transform the U.S. healthcare system, improving health outcomes, enhancing the patient experience and lowering per capita healthcare costs.
Key Points:
- More than a decade ago, a new framework called the Triple Aim was developed to optimize the United States healthcare system
- The Triple Aim focuses on three central things: improving health outcomes for patients, enhancing the patient experience and reducing the cost of healthcare
- More recently, a fourth tenet—improving the doctor experience—was added to the Triple Aim, creating the Quadruple Aim
In 2007, the Institute for Healthcare Improvement introduced the Triple Aim, a framework created to optimize and improve the United States healthcare system.
Since then, organized customers have sought to achieve the Triple Aim in order to deliver high-value care to all patients in a cost-effective manner.
As the name suggests, the Triple Aim focuses on three central tenets:
- Improving the health outcomes for patient populations
- Enhancing the patient experience
- Reducing the per capita cost of care
Achieving the Triple Aim is a truly collaborative effort. It involves an enrollment of a patient population, a commitment to universality for its members and the participation of an organization that works to achieve the three tenets of the Triple Aim by partnering with individuals, overhauling the delivery of primary care, managing population health and finances and integrating the healthcare system as a whole.
As these organized customers work toward achieving the Triple Aim, they continually collect and analyze data to assess whether their efforts are working or whether they need to revise their approach.
The Three Tenets of the Triple Aim
Let’s take a look, more granularly, at the three central tenets of the Triple Aim and what healthcare organizations need to do in order to achieve it.
- Improving the health outcomes for patient populations
If you improve healthcare outcomes for certain subpopulations, you improve healthcare outcomes for the entire population.
The Triple Aim breaks patient groups into several segments—like income, race, ethnicity, disease burden and patients served by the same health systems.
By measuring mortality rates, health statuses, life expectancy and disease burdens—and tracking progress or a lack thereof—organized customers can determine whether they’re making progress on the Triple Aim or whether a new way forward is needed.
- Enhancing the patient experience
The Triple Aim also focuses on improving the patient experience and getting patients and their families more involved in treatment and care. The thinking, here, is that the more engaged patients are, the more likely they’ll be to enjoy better healthcare outcomes.
As it stands today, however, only 12% of adults have proficient health literacy. More than half of patients who have chronic conditions are not health confident.
Add it up, and patients are collectively less likely to seek out medical help or take their medications as directed. In fact, as many as 30% of prescriptions remain unfilled; 50% of medications are not taken properly. Altogether, 125,000 patients die each year for failing to follow their doctor’s orders.
Enhance the patient experience and increase the chances they follow their doctors’ orders.
- Reducing the per capita cost of healthcare
Improve population health outcomes and the patient experience and you’ll reduce the per capita cost of healthcare—something that’s certainly needed to fix the U.S. healthcare system.
Part of the reason healthcare costs are so high today is because patients are not receiving care at the right time. One-third of the money spent on healthcare is wasted on things like unneeded tests, duplicated labs, the poor transfer of patient records and other things.
Fulfilling the Triple Aim requires a combination of intrinsic and extrinsic incentives.
Intrinsically, organized customers create an atmosphere of accountability through increased transparency while using data to continue to improve processes.
Extrinsically, as patient health outcomes improve and costs come down, the organizations are rewarded from happier patients and healthier bottom lines.
The Rise of the Quadruple Aim
As organizations made progress on achieving the Triple Aim, they realized it was much harder to achieve their goals when doctors are exhausted.
Unfortunately, the data paints a rather bleak picture:
- 68% of physicians and 73% of internists said they’d choose a different specialty if they could start their careers over again
- 34% of nurses and 37% of nursing home nurses are burnt out
- More than 50% of doctors may be burnt out in part because every hour of clinician-patient interaction can translate into two hours of documentation, administrative and clerical tasks
To improve these figures, we’ve seen the emergence of the Quadruple Aim, which adds a fourth tenet to the Triple Aim: improving the doctor and provider experience.
When doctors are burnt out, it negatively impacts the quality of care. Provider productivity takes a hit and turnover increases, increasing costs. Exhausted doctors are also more likely to receive lower patient satisfaction scores and more likely to have made a major error within the last three months, hurting healthcare outcomes.
By improving doctor and provider happiness and engagement, meeting the other three tenets of the Triple Aim is that much more attainable.
What might this look like in practice?
As an example, the Department of Family Medicine at the University of Colorado health system recently instituted a team-based model called APEX. Under this system, medical assistants gather data, set agendas, get medications, identify opportunities and document patient visits. The goal, here, is to streamline workflows so that doctors can practice medicine without drowning in administrative tasks.
APEX has already delivered impressive results. Within six months of launching, physician burnout rates fell from 53% to 13%. The practice also witnessed an improvement in pneumococcal vaccination rates and patient referrals for mammograms and colonoscopies. Since APEX enabled the practice to increase productivity and efficiency, they were able to see three extra patients per doctor per day while reducing wait times for new patients.
As organized customers become increasingly more prevalent and more and more healthcare organizations strive to achieve the Quadruple Aim, pharmaceutical clients need to adopt new strategies to effectively engage them.
After all, achieving the Quadruple Aim is the strategic foundation for success in the new healthcare environment. Targeting the Quadruple Aim helps practices and providers satisfy the needs of many of the alternative payment models are out there.
Stay tuned: In our next post, we’ll explore the strategies pharmaceutical companies must adopt in order to remain competitive in today’s evolving healthcare market.