MHA 505 Week 2 Triple Aim Executive Summary Example

Better Care, Better Health, Lower Cost for 1,900 People With Heart Failure: An Executive Summary Applying the Triple Aim to One Hospital's Population

[Student Name]

University of Phoenix

MHA/505: Systems Thinking in Health Care Environments

Week 2 Assignment

[Instructor Name]

[Date]

The hospital, its population, costs and proposal are composites written for a model paper; the framework and research come from the sources listed.

Executive Summary

The hospital should adopt adults with heart failure as its first Triple Aim population. The 1,900 patients in this group are readmitted at a rate of 23% within 30 days, rate the hospital's discharge information below most peers and cost an average of about $31,000 per patient per year across all settings. A coordinated program linking the hospital, cardiology, primary care, a partner skilled nursing facility and home health, led by the care transitions director as integrator, could improve experience, health and cost together. The first-year investment is $640,000, and the request is for approval of a 12-month program with quarterly reporting.

The Triple Aim

The Triple Aim, proposed in 2008, holds that health systems should pursue three goals at once, making each person's care better, making the whole population healthier and bringing down what care costs per person (Berwick et al., 2008). The authors argued that pursuing any one alone can harm the others; cutting costs can worsen experience, and improving individual care without attention to population health can raise costs. Pursuing all three requires balance.

Preconditions

The framework's authors identified conditions for success: a defined population, policies that ensure equity and constrain resources and an integrator, an organization or role that accepts responsibility for all three aims for that population and coordinates the parts of the system (Berwick et al., 2008). The hospital has none of these for heart failure today. No one is responsible for patients across settings, and each department measures only its own results.

Defining the Population

The population includes adults with a heart failure diagnosis who were hospitalized at the hospital or seen in its cardiology or primary care clinics in the past year, about 1,900 people. Their median age is 74, 38% live alone and 29% have both heart failure and diabetes.

Baseline: Experience of Care

On the hospital's patient experience survey, heart failure patients rated the discharge information domain at the 58th percentile nationally. In interviews, patients said they left without knowing which symptoms should prompt a call or whom to call, and several family caregivers said they learned about diuretic doses only when a home health nurse arrived days later.

Baseline: Population Health

Thirty-day readmission is 23%. Only 59% of patients see a clinician in the first week after going home, and 44% have documented daily weight monitoring at home. About 18% of the population visited the emergency department three or more times last year.

Baseline: Per Capita Cost

Using claims data from the two largest payers and the hospital's cost data, average annual spending across all settings is estimated at about $31,000 per patient, with inpatient care accounting for 58%. Spending is highly concentrated: 20% of patients account for about 65% of spending, which suggests where the program should concentrate its most intensive services.

Tensions Among the Aims

The aims can conflict. Reducing readmissions by discouraging returns to the hospital could lower cost while harming health, a risk shown by evidence that readmission penalties may have coincided with higher heart failure mortality. The program therefore tracks mortality and emergency visits alongside readmissions, every quarter and by patient group. An aim achieved by shifting harm to another aim is not an improvement; it is a trade.

Lessons From Seven Years of Practice

A review of organizations that pursued the Triple Aim over its first seven years found that success depended on three principles: creating the right foundation for population management, managing services at scale for the population and establishing a learning system to drive and sustain the work (Whittington et al., 2015). The proposal follows these principles: a registry of the population, standard services delivered to everyone who needs them and monthly measurement and adjustment.

A Fourth Aim

Clinicians caring for heart failure patients report heavy workloads and frustration with fragmented care. Physicians writing about the Triple Aim have argued for adding a fourth aim, improving the work life of clinicians and staff, because burnout undermines patient experience, population health and cost control (Bodenheimer & Sinsky, 2014). The program adds a measure of staff experience for the teams involved.

Why Heart Failure First

Other populations were considered, including patients with chronic lung disease and frequent emergency department users. Heart failure was chosen because its readmissions are measured and penalized, its evidence base for transitional care is strong, its patients are easy to identify from diagnosis codes and clinic lists and the care transitions work already under way gives the program a starting team. Success with one well-defined population would create methods and credibility for the next.

Who Pays and Who Saves

A Triple Aim program exposes a financial problem: the hospital bears most of the cost of transitional care, while savings from avoided admissions flow partly to payers. Under fee-for-service payment, an avoided admission also means lost revenue. The chief financial officer's analysis showed that the program makes financial sense mainly because of readmission penalties, the hospital's growing share of patients in accountable care contracts that share savings and capacity freed for more complex patients. The proposal asks the two largest payers to share part of the savings in the second year.

The Integrator's Role

The integrator is not a new department but a role with authority across settings: the care transitions director will convene the partners monthly, own the registry, track the measures and escalate problems to the executive team. Partners retain their own management; the integrator coordinates them around a shared population and shared results.

The Proposal

The program includes a registry of the 1,900 patients with risk levels; a transition nurse who sees high-risk patients before discharge and calls within 48 hours; reserved clinic appointments within seven days; a home weight monitoring program for the highest-risk 300; a shared care plan with the partner nursing facility and home health agency; and monthly review of results.

Costs and Expected Returns

First-year costs total $640,000 for staff, scales and connectivity, training and analytics. If readmissions fall from 23% to 18%, avoided admissions and lower penalties could offset most of the cost within two years, and patients would benefit sooner.

Measures

Experience: discharge information percentile. Health: 30-day readmissions, seven-day follow-up, 30-day mortality and emergency visits. Cost: per capita spending. Staff: a brief work-life survey. All are reported quarterly.

The Request

Approve the 12-month program, name the care transitions director as integrator for the heart failure population and receive quarterly results.

Conclusion

The Triple Aim offers a way to improve care, health and cost together for a defined population. Heart failure is the right first population for this hospital: its needs are clear, its costs are high and the parts of the system that serve it can be connected. With an integrator, a registry and a learning system, the hospital can pursue all three aims, and a fourth, at once.

References

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573-576. https://doi.org/10.1370/afm.1713

Whittington, J. W., Nolan, K., Lewis, N., & Torres, T. (2015). Pursuing the Triple Aim: The first 7 years. The Milbank Quarterly, 93(2), 263-300. https://doi.org/10.1111/1468-0009.12122