The stated goal of Patient Protection and Affordable Care Act (PPACA) (i.e. Obamacare) and healthcare reform is what people like to call the Triple Aim. For those not familiar with it, it goes as follows:
- Improve patient satisfaction and quality of care
- Improve the health of the community/population
- Reduce the cost of healthcare.
I’ve regularly heard people reference the triple aim as a reason why we should act a certain way. They refer to the triple aim as the main goal of what we are doing with healthcare IT. It’s the unifying vision for which all of healthcare wants to achieve.
I’m here to tell you that it’s just not the case. There are plenty in healthcare that couldn’t care less about the triple aim of healthcare. Many in that group are doctors. Ok, maybe the word “care” isn’t the right one. They do care about patient satisfaction and quality of care. They do want the health of their community to be better. They do want the costs of healthcare reduced. They do care about those things, but do they care to the point where it will actually spur action?
Another way to look at this is do they care about the triple aim enough for them to change what they’re doing. Plus, do they care about other things more than the triple aim.
Let’s look at them backwards. Do doctors want to reduce the cost of healthcare? As citizens, of course they want the cost of healthcare reduced, but with one small caveat: As long as it doesn’t mean I get paid less. This isn’t a knock on doctors either. This is the perfectly rationale response to the idea of lowering costs in healthcare. It’s not something we should criticize. It’s something we should understand and apply to whatever we’re trying to achieve.
The same thing applies to improving the health of a community or population. Hopefully the shift to value based reimbursement, population health, and ACOs will help to realign the incentives to make it so doctors care more about this than they do now. Otherwise, many of these programs look like we’re asking our providers to provide more free work for the benefit of the community. Hard to blame them when you phrase it like that, no?
The majority of doctors embrace this first aspect of the triple aim. They really want to provide the very best care they can to the patients (with a few sad exceptions which give a bad name to the hundreds of thousands of doctors who are doing their best). The question I’d ask ourselves is are we putting doctors in a position where they can have satisfied patients who receive quality care or are we burdening our highest paid resource with tasks that don’t work towards this end goal? Every doctor I know would welcome the opportunity to have better satisfied patients and improved outcomes.
I love the components of the Triple Aim as an ideal, but as it is today I think there’s a misalignment between the ideal and the day to day reality for doctors. I’m not against being idealistic and ambitious in our goals. Although, don’t expect our healthcare system to reach the triple aim if we don’t realign the incentives. Plus, let’s not forget that not all incentives are financial.