Reforming Health Care
Reforming Health Care
The Triple Aim
In 2008, Don Berwick, MD, and his colleagues at the Institute for
Healthcare Improvement (IHI) first described the Triple Aim of a
value-based health care system (Berwick, Nolan, & Whittington,
2008): (1) improving population health, (2) improving the patient
experience of care, and (3) reducing per capita costs. This
framework aligns with the aims of the Affordable Care Act. Reforming Health Care
The Triple Aim represents a balanced approach: by examining a
health care delivery problem from all three dimensions, health care
organizations and society can identify system problems and direct
resources to activities that can have the greatest impact.
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Looking at
each of these dimensions in isolation prevents organizations from
discovering how a new objective, decreasing readmission rates to
improve quality and reduce costs, for instance, could negatively
impact the third goal of population health, as scarce community
resources are directed to acute care transitions and unintentionally
shifted away from prevention activities. Solutions must also be
evaluated from these three interdependent dimensions. The Triple
Aim compels delivery systems and payors to broaden their focus on
acute and highly specialized care toward more integrated care,
including primary and preventive care (McCarthy & Klein, 2010). Reforming Health Care
The IHI (n.d.) identified these components of any approach
seeking to achieve the Triple Aim:
• A focus on individuals and families
• A redesign of primary care services
• Population health management
• A cost-control platform
• System integration and execution
Note that these possess the goal of creating a high-performing
health care system but do not focus on geographic communities or
social determinants per se. However, these two concepts can be
incorporated into the Triple Aim of improving the health of
populations and reducing health care costs.
The Triple Aim is easy to understand but challenging to Reforming Health Care
implement because it requires all providers, including nurses, to
broaden their focus from individuals to populations. The success of
the nursing profession’s continued evolution will hinge on its
ability to take on new roles, more cogently and creatively engaging
with patients and stepping into executive and leadership roles in
every sector of heath care. But it must do so within an
interprofessional context, leading efforts to break down health
professions’ silos and hierarchies and keeping the patient and
family at the center of care Reforming Health Care .
