The Triple Aim and Rural Health: So What’s New? David A. V. Reynolds, DrPH
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Presentation Outline • Why the Triple Aim? • Triple Aim: What is It? • Triple Aim: New to Rural Health? • Triple Aim: Can Telehealth Advance It?
Why the Triple Aim? Life Expectancy & Health Care Spending 84 JPN ESP SWZ AUS SUE ITA ISR FRA CAN LUX ISL NOR NZL GBR KOR AUT NLD 80 FIN DEU PRT IRL BEL GRC DNK CHL SVN USA CZE Life Expectancy in Years 76 POL MEX EST SVK CHN HUN TUR BRA 72 IDN RUS 68 IND 64 $0 $2,000 $4,000 $6,000 $8,000 Health Care Spending/Person OECD Health Statistics, 2013
Why the Triple Aim?
Why the Triple Aim?
Triple Aim: What is It? A Framework developed by the Institute for Health Care Improvement that seeks to optimize health system performance by simultaneously pursuing three dimension: • Improving the patient experience (including quality & satisfaction); • Improving the health of populations; and • Reducing the per capita cost of health care
Triple Aim: What is It?
Triple Aim: What is It? Health Delivery System Transformation Critical Path Coordinated Seamless Community Integrated Acute Care System 1.0 Healthcare System 2.0 Healthcare System 3.0 Community Outcome Integrated Accountable Care Healthcare Episodic Non- Integrated Care ● Healthy population centered • Patient/person centered ● Population health focused strategies • Transparent cost and quality ● Integrated networks linked to community • Episodic health care performance resources capable of addressing psycho • Lack integrated care networks • Accountable provider networks social/economic needs • Lack quality & cost performance designed around the patient ● Population-based reimbursement • Shared financial risk transparency ● Learning organization: capable of rapid • HIT integrated • Poorly coordinated chronic care deployment of best practices management • Focus on care management ● Community health integrated and preventive care ● E-health and telehealth capable
Triple Aim: What is It? IHI components of a system that would fulfill the Triple Aim: Focus on Individuals & Families Emphasis on Primary Care Services Management of Population Health Cost Control System Integration
Triple Aim: New to Rural Health? The Evolution of Northern Counties Health Care • 1976: Northeast Kingdom of Vermont Lowest per capita income in state All three counties federally-designated as medically underserved Yet, a community vision of what could be
Triple Aim: New to Rural Health? The Evolution of Northern Counties Health Care By 2007, an integrated system: 6 Federally Qualified Health Centers 2 Dental Centers a Medicare-certified Home Health & Hospice serving 2 out of 3 residents in its service areas with a 300-member staff EHR system before Fletcher Allen Health Care 1 st NCQA-certified medical homes in Vermont 1 st Blueprint for Health community
Triple Aim: New to Rural Health? Vermont’s Blueprint for Health (2006) Codified in State statute as a “program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination & management.”
Triple Aim: New to Rural Health? Vermont’s Blueprint for Health • NCQA-certified patient-centered medical homes (121 PCMHs serving 82% of Vermonters) • Multi-disciplinary Community Health Teams • All-insurer (public & private) payment reform & CHT support • Health information technology for population management • Evidence-based self-management programs
Triple Aim: New to Rural Health? Vermont’s Blueprint for Health Results in 2012 (N = 240,000) (Blueprint Annual Report: 2013) Lower Hospital Discharges Increase in Primary Care Visits Breast Cancer Screening Cervical Cancer Screening Emergency Room Use
Triple Aim: New to Rural Health? Vermont’s Blueprint for Health Savings vs. Investment in 2012 (N = 240,000) (Blueprint Annual Report: 2013) Total Saved vs. Total Invested Ratio of Gain to Comparison Investment Group Commercial $93.2 M $5.9 M 15.8 Insurance Medicaid w/out $23.6 M $2.9 M 8.2 Special Services Medicaid with $6.4 M $2.9 M 2.2 Special Services
Triple Aim: Is It Enough?
Vermont Health Care Reform Goals: Quadruple Aim! Assure that all Reduce health Vermonters have care costs and access to and cost growth coverage for high quality care Assure greater Improve the fairness and health of equity in how we Vermont’s pay for health population care 19
Triple Aim: Can Telehealth Advance It? Duh! • Integrating Primary & Specialty Care • Linking Rural & Urban Health Care • Overcoming Professional Isolation • Monitoring & Engaging the Active Patient • Avoiding Duplication & Reducing Cost • Advancing Payment Reform . . . And finally, but most importantly,
Triple Aim: Can Telehealth Advance It? Telehealth is a Two-way Street.
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