The Triple Aim

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The singular best assertion of the connections between health policy, clinical medicine, and public health comes from none other than Dr. Donald Berwick. As the former Administrator of the Centers for Medicare and Medicaid Services (CMS), former Vice Chair of the U.S. Preventive Services Task Force (USPSTF), a pediatrician by training, and dozens of other accolades, there is hardly anyone better versed in the interwoven web of medicine and policy. His expertise, coupled with experts in health care quality improvement and patient safety, resulted in The Triple Aim, a set of interconnected goals aimed at improving U.S. health care through political, rather than technological or biomedical, avenues.

The Triple Aim philosophy, as outlined in a seminal paper in Health Affairs, is as follows: “the United States will not achieve high-value health care unless improvement initiatives pursue a broader system of linked goals. In the aggregate, we call those goals the “Triple Aim”: improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.” The ACA incorporated the goals of the Triple Aim (essentially making it the national health care strategy) through a variety of measures, including the creation of new quality metrics for providers, establishment of the Prevention and Public Health Fund, expansion of access to health insurance through public and private programs, innovation of care delivery models, and much more.

Even though health insurance is not equivalent to access to health care services (a common misconception), the rate of uninsured adults did hit an all-time low of 12.7% in early 2016. This was the culmination of a downward trend in the uninsured rate which has increased to 15.5% in the early part of 2018. Recent political actions have exacerbated the rising number of individuals without coverage, including the current Administration’s decision to shorten the open enrollment period for the Marketplace, the elimination of financing for open enrollment advertising and outreach, and conflicting messaging from Administration officials about the status of the law.

While efforts on a federal level to improve health and health care delivery have moved away from some intents of the ACA, localities are making great strides with the Triple Aim. With national health care expenditures continuing to climb and various health care indicators ranking the U.S. last or near last among other wealthy nations, it is clear that something must change. This is yet another reminder that providers need to understand the system they practice in and, if interested, seek opportunities to help their patients through policy. Learn more about the Triple Aim and health care improvement from Dr. Berwick’s Institute for Healthcare ImprovementRead a report, take a training, attend a conference. And if you’re a medical student interested in health care improvement, patient safety, and quality, look into the IHI Open School! 

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