Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
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
DEUGRC
HUN
ISL
IND
IDN
IRL
ISR ITA
JPN
KORLUX
MEX
NLDNZL NOR
POL
PRT
RUS
SVK
SVN
ESPSUE
SWZ
TUR
GBR
USA
64
68
72
76
80
84
$0 $2,000 $4,000 $6,000 $8,000
Health Care Spending/Person
Life
Exp
ecta
ncy
in Y
ear
s
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?
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.