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Do Doctors Care About the Triple Aim?

Posted on May 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Stand-Out Themes at HFMA #ANI2013

Posted on June 24, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

My third trip to the HFMA ANI show was by far the best yet, for a number of reasons. I found the overall event to be easily manageable in terms of way finding, session offerings and overall organization. Every HFMA volunteer I encountered had a smile on their face, and that’s saying something at 7:15 three mornings in a row. This positive attitude was also evident in the brief keynotes given by the association’s executives and board members, including Ralph Lawson, Steve Rose, Melinda Hancock and Joe Fifer. Each exuded an air of gratefulness at being put in a position of leadership, and seemed optimistic – yet realistic – about the future of healthcare.

Rose was particularly realistic in his comments, noting that the event’s theme of “Whatever it Takes” is one that he applies to his own life, most notably (visually at least) in the area of weight loss. I have to admit, it’s always nice to see healthcare professionals being healthy. (I didn’t see many taking advantage of the doughnuts during the continental breakfast each morning, though everyone does seem to love their caffeine and a few even snuck a cigarette – yuck!)

The only tone of dissension I detected amongst HFMA’s ranks was a result of the keynote given by Joe Gibbs, a celebrated football coach and racing team owner unknown to me before the event. As Gibbs spoke about leadership and picking the right players, I wondered how his testosterone-fueled keynote would compare to the first “Women as Leaders” session held a few days later. While Gibbs’ presentation was so-so, the female-centric session held a few days later was amazing. It was at times confessional in tone, always blunt and occasionally tear-inducing. Five HFMA board members shared their struggles, their triumphs and advice around working, parenting and trying to juggle both. It was refreshing to hear each of them go off script – touching on faith, values, husbands, kids and extended family.

I had the chance to attend most of the keynotes, a session on the challenges faced by small, independent hospitals, and the Women as Leaders panel. I spent a ton of time in the exhibit hall, and will cover that part of the show in next week’s post. For now, I’ll cover some high-level themes I gleaned from talking with attendees and exhibitors, and share a few pictures.

1. It’s time for hospitals to be more proactive in reaching out to payers and physicians, especially when it comes to sharing data. I had no idea that the “H” in HFMA once stood for Hospitals, so this inclusiveness has been in the works for some time. My thinking is that as the industry consolidates and hospitals try to become payers, payers buy hospitals, and physicians get caught in between, it’s only natural that an association like HFMA broaden its horizons to better serve its constituents.

2. Value-based care seems to the new name for accountable care and/or coordinated care. It’s certainly a phrase that will resonate better with consumers, which leads me to number three.

3. Everyone is aware of the need for more transparency into healthcare costs. Consumers have become more vocal in demanding it, and some hospitals are beginning to see the light, offering pre-service estimates. In fact, Fifer announced that HFMA has formed a task force to address the issue of price transparency in healthcare. You can view his announcement below:

4. Health insurance exchanges were covered copiously in sessions I was unable to attend. The “what ifs?” certainly outnumbered the “without a doubts.” I’ll be interested to see how these conversations go next year, once every state is in deep.

5. I did not hear one mention made of mobile health during the entire conference. I realize the attendee demographic is more finance than IT, but I would have thought at least one or two sessions would have addressed mobile health and the benefits this concept and technologies bring to healthcare’s bottom line. Isn’t mobile health key to cost containment and patient engagement?

vista

I’m beginning to think Orlando is my favorite city for conferences. This picture pretty much says it all – beautiful area of town, sunny skies with the typical once-a-day shower, and definitely warm. Even though it was humid, the outside atmosphere was a welcome respite from the absolutely freezing temperatures inside the convention center.

gibbs

Joe Gibbs gave Monday morning’s keynote. He kept referring to “salesmen,” which made me wonder if he’d been properly debriefed.

smallhospitals

This was a pretty interesting panel on the fate of small, independent hospitals. It helped paint a much clearer picture for me of the competitive markets these types of hospitals face.

Berwick slide

Dr. Don Berwick, former head of the CMS, gave my favorite keynote on Tuesday morning. It was fairly high level in nature, but he presented seven or eight examples of healthcare organizations that were taking the term “value-based care” to new levels. He referred to the much venerated “Triple Aim” often, and shared a number of slides, including the one above on “The Structure of the Affordable Care Act.” Notice the word “partial” at the end. To me, this slide conveys the complexity and somewhat confusing nature for the ACA.

That’s all for now. I’ll follow up next week with observations from the exhibitors hall. I’d be interested to hear from anyone else who attended what they took away from the event.