When the Triple Aim Initiative was launched in 2007 by the Institute for Healthcare Improvement (IHI), it was viewed as a groundbreaking, patient-centric solution to improve the U.S. healthcare system by simultaneously aspiring to three “aims”: improving patient experience of care, improving population health and reducing the per capita costs of care.
However, it quickly became apparent to healthcare professionals that the Triple Aim had a very significant shortcoming – it didn’t take them into account. Physicians were experiencing burnout, which was having the opposite effect of the original intention of the Triple Aim, and .
To combat provider burnout while continuing to maintain the same level of care to patients, the Quadruple Aim was developed. The Quadruple Aim added a very important fourth dimension to the original Triple Aim – care of the provider.
Patient-Focused Triple Aim
The Triple Aim seeks to improve the health of populations by enhancing the quality of patient care while reducing the per capita cost of healthcare. To best understand how these three facets work together, we must first understand how the Triple Aim seeks to improve the patient experience of care by focusing on quality and patient satisfaction.
Enhanced Patient Experience
The first part of the Triple Aim framework focuses primarily on enhancing the patient experience within the healthcare system.
There are many significant parts to improving patient experience, including:
- Ensuring patients are knowledgeable about their diagnosis and fully understand their condition. When physicians take the time to talk to the patient, look them in the eye, speak to them in plain language, and show compassion, it improves patient satisfaction and therefore improves the overall patient experience. Improving health literacy in patients is also an important aspect in actively engaging a patient in their care plan, and improving patient outcomes, which in turn improves patient experience and satisfaction.
- Improving access to care in rural areas. When patients have ease of access to quality healthcare, especially telehealth solutions like hospital-in-home, and remote monitoring devices, it helps improve their patient experience. Improved access to care truly supports the Triple Aim as a whole, as it ultimately improves population outcomes and reduces per capita costs.
- Using team-based care to improve the patient experience. To further the transition to value-based care models in the healthcare industry, team-based care focuses on engaging all members of a patient’s healthcare team to work together, and to the extent of their education, certification, and specialties. This not only facilitates a deepened relationship between healthcare professionals but simultaneously improves patient satisfaction by promoting teamwork amongst providers.
Improved Population Health and Patient Outcomes
Improving population health is the second facet of the Triple Aim. By taking a population health approach, healthcare providers and organizations can improve patient outcomes for specific populations sharing the same or similar conditions, like diabetes, COPD, or CHF.
- Identifying risk factors. Certain modifiable risk factors are leading to many chronic diseases that span across all populations, including poor diet, tobacco use, alcohol use, and physical activity. Each of these risk factors contributes to specific health conditions, including obesity, liver disease, hyperglycemia, high triglyceride levels, and hypertension. Screening for and educating patients about these risk factors leads to improved population health by reducing said risk factors leading to chronic diseases.
- Transitioning from volume-based care to value-based care. The United States health system has traditionally been focused on volume over value. Providers have not been incentivized to consider how the astronomical cost of healthcare negatively impacts population health by limiting access to those with limited means or without access to affordable health insurance.
Although the shift to value-based care has begun, the process is slow and quality, affordable healthcare is still not accessible to all patient populations. Telehealth and remote monitoring can be cost-effective ways to bridge the financial gap and provide value-based care to patient populations that previously lacked access.
- Focusing resources to promote overall health. It is common knowledge that people living in poverty or who are disadvantaged in some way have less access to healthcare, leading to poorer health than those with financial means and advantages. Focusing on these populations is crucial to improving overall population health, as that is where the need is greatest. By spending more resources on disease prevention and health promotion, patient outcomes can be drastically improved through the development of healthier communities.
- Segmenting patient populations. Populations can be naturally grouped by modifiable and non-modifiable risk factors like age, disease, condition, and lifestyle habits, as well as similarities like gender, demographics, behaviors, and social factors. By segmenting populations using risk stratification, providers can identify the precise services and care for each population segment.
This facet of the Triple Aim seeks to provide improved patient experience and outcomes while reducing the per capita cost of healthcare. The aim is to enhance the health of people so that they don’t require visiting service providers more often. The Triple Aim attempts to reduce waste in healthcare while simultaneously increasing the value of care provided.
To improve clinical care within the Triple Aim, healthcare professionals are required to work across patient populations and disciplines.
Specific care and payment models to help achieve the Triple Aim while reducing costs include:
- Building care coordination and management systems.
- Designing a care delivery model that is patient-centric.
- Incorporating social health determinants and behavioral health with physical health to deliver a complete model of care.
- Engaging both patients and the healthcare system with the necessary technology and information.
Optimizing Health System Performance with Quadruple Aim
The Triple Aim’s patient-centric model led to significant, evidence-based physician and clinician burnout, as it required healthcare professionals to extend themselves far beyond what they were traditionally accustomed to.
Physician burnout had the opposite effect on the Triple Aim as was intended, leading to decreased patient satisfaction. This caused the initial move from Triple to Quadruple Aim, with the goal of improving the healthcare system not just for the patient, but for the provider as well.
When was the Quadruple Aim Introduced?
In a 2014 Annals of Family Medicine paper, Thomas Bodenheimer, MD first introduced the idea of The Quadruple Aim.
Bodenheimer recognized the negative impact of physician burnout of the Triple Aim and sought to rectify this by taking the provider into account. By adding a fourth, physician-centered element to the Triple Aim – improved clinical experience – Bodenheimer argued that quality patient care starts with the provider.
Improved Clinical Experience
According to a 2014 study, thanks to overwhelming physician burnout, 73% of internists and 68% of family physicians wouldn’t choose the same specialty if given the opportunity. Burdened with administrative tasks like paperwork, completing EHRs, and answering emails, 87% of physicians indicated their stress and burnout were primarily caused by these tasks.
Value-based healthcare is more prevalent, making the quality of patient care more important. This starts with the provider. When healthcare professionals are unable to find joy in their work, they are no longer able to provide the highest quality care possible.
According to the MEMO study, physician burnout could potentially contribute to the misuse of valuable resources, which could lead to increased costs of care. This has the opposite effect on the Triple Aim as was originally intended, which led to the development of the Quadruple Aim, with a fourth, physician-centered facet to the healthcare model – improved clinical experience.
Implementable Solutions to Help Achieve the Quadruple Aim
As a leader in the Connected Health space for over 10 years, Trapollo supports providers and payors throughout their role within the Quadruple Aim.
Trapollo Converge™ is our innovative virtual care platform that seamlessly integrates into your existing workflow, helping to reduce clinical burdens and administrative burnout at a lower cost. A powerful patient engagement platform, Trapollo Converge makes it easy for clinicians to communicate with patients and delivers actionable data to health systems, fostering a collaborative, value-based care model.
Further supporting the Quadruple Aim, Trapollo Converge features a Consolidated Clinical Care Team Dashboard that can be customized by disease state, allowing accurate, data-driven population segmentation and supporting the creation, revision, and management of comprehensive, disease-specific care plan templates.
Clinical burnout leads providers to lose sight of why they first went into medicine in the first place – to help people. At Trapollo, we believe in making healthcare more human. More kind. And that doesn’t just stop at the patient. Partner with us to learn how our solutions help achieve the Quadruple Aim of healthcare, one person at a time.