Merging of the Triple Aims

Part 4 of 4 – Where our Healthcare Institutions and Retirement Communities unite with a model of improved healthcare services and delivery.

Our healthcare institutions and communities need each other.  But these 2 entities need an easier and more cooperative way of interfacing.  And each needs to do some changing.

Our institutions need to provide services that are more affordable while still rewarding providers.  They also need to develop care models that lead to better health of the community without alienating patients by making access to necessary services and treatment so confusing, cumbersome, complicated, intimidating, and expensive.

Our communities must be more self-reliant by recognizing that the great majority of the healthcare services they require are not provided solely within institutional walls but may also be provided by private businesses located in their neighborhood that are poised and eager to serve and who can deliver their services in the comfort and convenience of the community resident’s home.  Communities must be more open to forming unique partnerships and employ innovative and creative new approaches that bring most of the needed healthcare directly to them where they live.

The unsustainable cost of healthcare in the US is forcing innovation in services and healthcare delivery.  House Calls proposes a creative approach that brings institutions and our communities together by merging the Triple Aims of each and connects them at points of shared function (“Touch Points”).

Our model initially limits our view of “communities” to Retirement Communities.  This addresses the population having the most chronic illnesses and where most of our healthcare dollars are allocated.  It is also where groups of the elderly live together and where healthcare can be delivered most efficiently.

We start with one Retirement Community at a time and develop a working model that can then be exported to all Retirement Communities, thereby relatively quickly affecting a very large population.  In our model, the goal that both Triple Aims share is very broad – “better outcomes.”  The approach must be broad because each Triple Aim achieves and measures this goal differently and according to its own customary practice:  institutions such as hospitals care for higher acuity patients and have access to numerical data (e.g. billing, cost of services, length of stay, rates of readmission, etc.) used for their metrics which is not readily available in the community.  In communities, however, care is delivered in the patients’ homes, and anyone experienced in this area will readily tell you that well-intended recommendations and advice delivered in the hospital or a physician’s office is VERY DIFFERENT than what actually transpires in a patient’s home.  And it is the community physician, the one delivering care on-site in the Retirement Community or the patient’s individual home, who sees what REALLY occurs and adjusts treatments and expectations accordingly.   Numerical metrics are not as available in this setting, but early intervention, reducing risks in the home, and building trusting relationships are measures that affect outcomes.

Although institutional and community approaches differ, they both practice state-of-the-art healthcare and cooperatively share information and resources at the Touch Points in the Figure.  Their focused attention will allow both to achieve the shared goal of improved outcomes, although each must accept that using different metrics for measuring these outcomes (numerical data vs. non-numerical data) does not invalidate the outcome itself.

There is much more to discuss, but we’ve still come a long way in this 4 part series.  From Dr. Berwick, to institutions and communities, to killing giants, and finally to the Merging of the Triple Aims.  We give a vision for improving healthcare to our senior citizens and a specific approach to providing better health, better care, and lower cost by implementing community-based healthcare delivery that emphasizes location of service, visibility of providers, and easy and convenient healthcare accessibility.

The good news is that despite the immensity of the topic, we can make a real and measureable difference in the healthcare of our senior citizens by starting small, “one toe at a time”, one Retirement Community at a time.  This is exciting, and if we keep the vision, work together, and open our minds, we can make a huge and tangible difference…NOW!

We invite your comments and criticism.  Both will only make us better.

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