The Triple Aim, that lofty set of goals that the healthcare system claims to have embraced:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and.
- Reducing the per capita cost of health care.
I agree with them and believe they are appropriate and necessary.
Everyone it seems, says they are working towards the Triple Aim, and many have taken to adding Provider Satisfaction and saying we in fact need a Quadruple Aim. Well, before we go there, let’s see what we are actually doing on the initial three.
After attending a number of conferences and seeing what the system is in fact doing, I’m fairly certain, that healthcare is not actually going after the Triple Aim. In fact, it appears that almost everyone has quietly agreed on the “Double Aim” in an effort to short-circuit any true progress and continue on the path we have been on.
What do I mean by the Double Aim? Here are some examples of things I saw, heard or didn’t hear at HIMSS 2018:
After listening to an excellent panel on innovation, by three leading health system executives who oversee their systems innovation area or department, I just had to ask a question:
“At what point does this innovation actually lower costs?” A murmur arose in the room.
Response one:
“Well we could spend a whole day on that one”
The next answer? Well, there wasn’t one.
At the conclusion of the session, Gregg Masters spoke with one of the panelists and asked if as part of their innovation center they were tasked with lowering costs. Their response “no, that’s not part of our charge.”
Why wouldn’t an innovation center also be looking for innovation that reduces costs?
At a dinner panel one evening, a health plan association executive when asked if health plans were really lowering costs, pointed to the Medical Loss Ratio (MLR) Rule (which I have written about here) as a key contributor to holding costs down. When I explained my belief that the MLR rule ensures costs go up because “who would want 15% of a lower number next year” there were audible chuckles of agreement in the room, a shocked look on the panelists face and the panel quickly switched to another topic. While the person who asked the original cost question, looked at me, raised his eyebrows and laughed.
I do not recall any booth or individual discussing programs that save money, in fact most were talking about revenue enhancement.
Only Kaveh Safavi of Accenture and one other presentation discussed the elephant in the room; that healthcare is the only industry where as it adds technology, the workforce gets less efficient. I would call the behavior we exhibit in this regard, an addiction. We continue to do it, even though the outcomes will be bad for us.
Do we not hear the clamor associated with the Amazon, Berkshire-Hathaway, JP Morgan?
“Healthcare is the Tapeworm of the American economy”
Or the announcement by Wal-Mart regarding their narrow network, in which they said that about 40% of people referred to their center of excellence for back surgery were told they don’t need it. How about the growing relevance of Dave Chase and the Health Rosetta and books like Dan Munro’s Casino Healthcare, or the Health Value Awards.
Even the esteemed Dr. David Nash of the Jefferson College of Population Health saying there are too many medical errors and too many tests being ordered and it was “time for doctors to look in the mirror”. But not just doctors, all sectors of healthcare, especially hospital systems, health plans, device and pharmaceutical manufacturers and vendors. You may be thinking you can slip by with the Double Aim, but others are AIMing to knock the inappropriate costs out of the system, and if you don’t get involved it might be you.
And now when CMS announces their Pathways to Success, a new ACO requirement that pushes ACOs which have been living off of one-sided risk in the MSSP program, and showing no savings, to two-sided risk, the industry goes bonkers.
We know there are excesses in the system – everyone talks about that, everyone talks about the Triple Aim – but it seems that in the case of doing things versus talking about the Triple Aim, we are truly only interested in the Double Aim.
Fred Goldstein is CEO of Accountable Health LLC.
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