Kevin Pereault, triple aim

Kevin Pereau

Making Sense of the Triple Aim & Triple Threat

By Kevin Pereau, “The Digital Health Guy”

Perhaps nobody simplifies the Triple Aim quite like Andy Slavitt. I first heard Andy talking about it at an event hosted by Glide Memorial and Abner Mason of Consejo Sano at J.P. Morgan’s Annual Healthcare event in San Francisco. Ever the mensch, Andy correctly credits Don Berwick, whose Institute for Healthcare Improvement (IHI) originally developed the concept.

The Triple Aim was intended to improve care across three broad dimensions. At its highest level, the Triple Aim strives to do the following:

  1. Provide better access to care
  2. Achieve better healthcare outcomes
  3. Make healthcare affordable for all

While much of the Triple Aim focuses on aligning incentives, partnerships, regulations and business models, it strikes me that the rise of digital health gives us a real opportunity to also address important cultural and behavioral changes required to really move the needle. It really does take a village and in healthcare, getting everyone rowing in the same direction is critical.

It is noble to have such lofty goals, but you had also better know the threats preventing you from making progress. The Digital Health crowd was attracted to healthcare to help us manage those threats. Conventional wisdom suggests there are three primary threats, but anyone reading the tea leaves will chime in there is a fourth threat emerging, and that is physician burnout.

Threat 1: Health Disparities

The harsh reality of our USA healthcare system is that your race, income and ZIP Code matter. Believe me when I tell you that the kids growing up in Danville, CA have a far different consumer experience than kids growing up in Oakland. It does not have to be like this. Access to care and affordability of care are something we are all entitled to and when that doesn’t happen, we all pay. Card face up—this is the one issue I have the most passion for and what brought me into the industry.

Threat 2: The Relentless Focus on Revenue

Newcomers to healthcare are often surprised to hear there are three threats, because the only one we seem to focus on is revenue. The first wave of investment in healthcare technologies focused on developing and evolving a common definition for “Meaningful Use.” This gave rise to Electronic Health Records (EHRs) which exploded onto the scene, keeping provider IT departments busy converting notes to e-files. Unfortunately, they were never designed to keep track of our healthcare records. Instead, they focused on billing and compliance. This provided little value for you or me, and turned our doctors into data entry clerks, all contributing to physician burnout. To this day, many providers turn white at the mere mention of digital health because their definition begins and ends with EHRs, which were a wretched experience.

Threat 3: The Politics of Healthcare

Let’s face it, even when we think we are talking about healthcare, more often than not, we are talking about politics. I just shared a panel at the World Health Congress in Washington, DC with Aneesh Chopra, former CTO under President Obama. Sharing the hotel with us was a rally for a political candidate famous for making healthcare a favorite talking point. You would expect to find common ground with this crowd, but it was obvious after just a short discussion, healthcare was nothing more than a construct for helping them get their candidate elected.

Whether your politics lean left, right or to the middle, this isn’t uncommon. If I had a magic wand, I would use it to help people understand that access to care is just one of the fundamental pillars that need to be managed. Quality and cost of care are equally important. Until the influence of voters equals the influence of the money and lobbyists influencing our policy, we will have problems.

I mentioned a fourth threat and that is physician burnout. Hippocrates would be spinning in his grave. The harsh reality of today’s US healthcare environment is that doctors have no choice but to worry as much about compliance as caring for their patients. Yikes!

I often tell people that we can’t solve healthcare with an ACA or ACO alone. It is a participative sport, and we all have a role to play. We need to identify and eradicate root causes while minimizing the effects of politics on healthcare.

Until the next time…to your health!

The Digital Health Guy

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