So Whats New? David A. V. Reynolds, DrPH My Business Card - - PowerPoint PPT Presentation

The Triple Aim and Rural Health: So What’s New?

David A. V. Reynolds, DrPH

My Business Card

Intentionally Blank

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

AUS AUT BEL BRA CAN CHL CHN CZE DNK EST FIN FRA DEU GRC HUN ISL IND IDN IRL ISR ITA JPN KOR LUX MEX NLD NZL NOR POL PRT RUS SVK SVN ESP SUE SWZ TUR GBR USA 64 68 72 76 80 84 $0 $2,000 $4,000 $6,000 $8,000

Health Care Spending/Person Life Expectancy in Years

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

• ptimize 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?

Outcome Accountable Care Coordinated Seamless Healthcare System 2.0

• Patient/person centered
• Transparent cost and quality

performance

• Accountable provider networks

designed around the patient

• Shared financial risk
• HIT integrated
• Focus on care management

and preventive care

Community Integrated Healthcare

• Healthy population centered
• Population health focused strategies
• Integrated networks linked to community

resources capable of addressing psycho social/economic needs

• Population-based reimbursement
• Learning organization: capable of rapid

deployment of best practices

• Community health integrated
• E-health and telehealth capable
• Episodic health care
• Lack integrated care networks
• Lack quality & cost performance

transparency

• Poorly coordinated chronic care

management

Acute Care System 1.0

Triple Aim: What is It?

Community Integrated Healthcare System 3.0

Health Delivery System Transformation Critical Path

Episodic Non- Integrated Care

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
• 1st NCQA-certified medical homes in Vermont
• 1st 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. Comparison Group Total Invested Ratio of Gain to Investment Commercial Insurance $93.2 M $5.9 M 15.8 Medicaid w/out Special Services $23.6 M $2.9 M 8.2 Medicaid with Special Services $6.4 M $2.9 M 2.2

Triple Aim: Is It Enough?

Vermont Health Care Reform Goals: Quadruple Aim!

Assure that all Vermonters have access to and coverage for high quality care Improve the health of Vermont’s population Assure greater fairness and equity in how we pay for health care Reduce health care costs and cost growth

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.