We seem to have a love/hate relationship with them. Even if we try not to, we find ourselves using them in meetings or in discussion with co-workers. In healthcare, the “Triple Aim” is one of these. The concept is great: Improving the patient experience of care AND improving the health of populations AND reducing the per capita cost of health care.
“Triple Aim” has definitely become “a buzz” within the behavioral health community over the past few years. Many behavioral health organizations have included it in their mission, vision or strategic plan. These important tools identify the direction of the organization.
But if the focus on the Triple Aim never escapes the C-Suite (CEO, COO, CFO, etc.), there is risk that it will not become embedded within the workplace culture and actually impact workflow, outcomes, and ultimately, the people whose lives it could benefit most.
It is far easier to discuss buzz words than actually adapt our business to reflect a new reality. To adapt to a new environment or the presence of a new variable is challenging. It’s also necessary. Adaptation can take years but ultimately can determine your organization’s survival.
Biologists are very familiar with this concept. Rosemary and Peter Grant are two researchers who spent almost 30 years researching the finch population on two small islands, Daphne Major and Genovesa, in the Galápagos archipelago, Ecuador. They found that there was a difference in the size of the ground finches’ bills between islands. The size of the bills was conditional upon which other finch species were present. To survive and thrive, these animals had to adapt. I propose that program managers within your organization need to be like those finches.
Program managers within behavioral health organizations have a great opportunity to use the Triple Aim as a foundation for program evaluation. My experience has been that a program manager’s time is often consumed by meetings, staff supervision, reviewing staff documentation, updating policy and procedures, preparing for audits and accreditation surveys, as well as the ever popular and time-consuming HR problems. With all these demands, it is no surprise that it can be very challenging to actually engage in meaningful program evaluation and identify any areas in which the team may need to adapt.
If you are leading a behavioral health program, such home based therapy or case management, the Triple Aim framework can be used to evaluate and improve the program.
Does your team utilize patient satisfaction measures? Are they meaningful or a survey that staff pass out once a year that most patients throw away? How are your staff collecting patient report of satisfaction on an ongoing basis? Do they simply check “satisfied” in the progress note if the patient didn’t seem upset about their services that day? Or do they have meaningful discussion with persons served about how services are helping them and any changes that need to be made? How do you measure quality of your services? Do you use fidelity measures for best practices? Once patient satisfaction and quality metrics are measured, do you share this information with staff? With persons served?
This one can seem pretty overwhelming. Behavioral health clinicians work very hard to keep those they serve out of jail, inpatient units, etc. Improving their health may feel like an impossible task — but it’s not! Start small, pick one population you want to target, such as children taking atypical antipsychotics or adults with diabetes and depression. Define clear goals and measures. Work closely with your information specialists and analysts to identify a way to collect data and track your outcomes. Implement Plan, Do, Study, Act (PDSA) cycles to improve care. Research shows that persons with severe and persistent mental illness die, on average, 25 years younger than the general population, often due to treatable conditions*. Therefore, it is critical that we adapt the care that we provide to be more integrated, focusing on overall health.
In some behavioral health organizations, program managers may think “How am I supposed to impact cost? Isn’t that the finance department’s job?” If you feel out of the loop regarding the cost of your program:
These activities only focus on the cost of your team’s services. That’s a good start. But to impact per capita cost, you have to look at all health care costs. This is a significant challenge.
Even though we now have growing access to encounter data and various data analytic software packages, many do not include cost data. There are some creative efforts at the local level to engage in dialogue with other health care providers via regional health improvement councils. What’s needed are data sharing agreements or releases of information to gain patient consent so that protected health information data can be shared.
Dialogue with community providers can help you identify ways to reduce the cost for specific populations. You could also try contacting a player, such as a Medicaid HMO, that provides coverage for a large portion of the population you are addressing. They may be willing to work with you on a pilot project and would be able to track the overall cost of your participants (for which they provide coverage).
In the ever-changing landscape of healthcare reform, it is increasingly critical for behavioral health providers to be competitive within the larger health care market. Now more than ever, we need to be able to demonstrate effective outcomes (evidenced by data!), competitive costs, and high patient satisfaction.
We encourage you to use team/individual goal setting and process improvement teams as an opportunity to integrate Triple Aim principles into your workflow and agency culture. This will help you to flourish in the era of integrated, value-based care. Implementing Triple Aim goals at the program level and monitoring progress with data will help ensure your success.
* For additional information please see Morbidity and Mortality in People with Serious Mental Illness,” published in October 2006 by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council (http://www.nasmhpd.org/) and an earlier report by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA), Sixteen State Study on Mental Health Performance Measures. Rockville, MD: DHHS Publication No (SMA) 03-3835; 2003).