IHI Virtual Expedition:Kick-Start the Triple AimSession 1: Set-up for Pursuing the Triple Aim
February 24, 2016
Begins at 11:00 AM ET
Matt Guy, MPACory Sevin, RN, MSN, NP
Today’s Host
Julie Landsman is a Project Coordinator with the Institute for Healthcare Improvement. She works with the Building Capability Group coordinating web-based offerings, as well as with the IHI Open School on video resources and course development. Julie graduated from Northeastern University in Boston, MA where she received a Bachelor of Arts Degree in Sociology with a focus in International Affairs.
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Goal of Series
Leverage a robust framework and guiding principles to
better manage populations towards the Triple Aim
Establish the governance, learning, and execution
infrastructure at all levels of your system
Manage and measure progress for a portfolio of system-
level projects
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Expedition Activities
5 90-minute webinars
Faculty:
– Matt Guy, MPA
– Kevin Nolan, Mstat
– Cory Sevin, RN, MSN
Focused Action Steps between webinars
All Teach, All Learn-drawing on your experiences
as you work with the action steps.
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Kick Start Call Topics
1. Set-up for Pursuing the Triple Aim – February 24th
2. Managing Populations – March 9th
3. Governance, Leadership, and Sustainability –
March 30th
4. Managing Services for Population and Portfolio
Management – April 13th
5. Triple Aim Measurement and Learning System –
April 27th
All calls from 11:00 AM - 12:30 PM ET
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Expedition Faculty11
Matthew Guy, MPA, is the Managing Director of the Pueblo
Triple Aim Corporation (PTAC). He recently served as
Executive Director of the Southeastern Colorado Area Health
Education Center (SECAHEC). SECAHEC serves 16 counties
in southeastern Colorado providing health education resources
and support for current and future medical professionals. Matt
has also worked for the Colorado Rural Health Center working
with safety net and rural health clinics in Southeastern
Colorado to improve the quality and effectiveness of their
practices. He has served as the 3rd Congressional District
representative on the Colorado Commission on Family
Medicine and works as a consultant with the Colorado Rural
Health Center, American Medical Association, and other
organizations in the areas of practice improvement and
community health needs assessments. Matt received his BA
from Central College (Iowa), has a master’s degree in Public
Administration from the University of Colorado, holds a 4th-
degree black belt in taekwondo, and is Commissioned Lay
Pastor with the Presbyterian Church USA in the Pueblo
Presbytery.
Expedition Director12
Cory B. Sevin, RN, MSN, NP, is a director with the
Institute for Healthcare Improvement. With IHI, she has
led work in spread, redesigning the clinical office
practice, improving transitions into home healthcare,
improving emergency department flow, and improving
transitions in care to reduce readmissions. Sevin is a
nurse practitioner with a clinical specialty in
adolescent, preventative and community health. Past
experience includes 26 years working in a variety of
community settings, including public health, schools,
and community health centers. Before coming to IHI,
she was vice president of operations at Clinica
Campesina, a community health center in Lafayette,
Colorado. She received her BSN in 1976 from the
University of Michigan and her MSN in 1980 from the
University of Cincinnati.
And You?13
Today’s Objectives:
Set-up for Pursuing the Triple Aim
Describe the IHI Triple Aim.
Identify strategic and financial reasons to pursue
the Triple Aim.
Identify key elements necessary for an aligned,
system-wide, strategic purpose for the Triple
Aim.
List team roles for a team within an organization
pursuing the IHI Triple Aim.
Polling Question
Our organizations long-term success depends on
attaining better health, better care experience and lower
per capita cost for specific populations we serve and our
strategy states it explicitly
Our strategy includes mention of better health, care
experience and per capita cost for specific populations
but these are not explicit goals.
Our board and senior leadership has discussed the
implications of the Triple Aim and we are beginning to
incorporate these ideas into our strategy
Our current strategy is not tied to the Triple Aim
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Definition of Terms
Triple Aim
Population Health
Population Management
Payment Reform
Definition
System designs that simultaneously improve three
dimensions:
– Improving the health of the populations;
– Improving the patient experience of care (including quality and
satisfaction); and
– Reducing the per capita cost of health care.
Determinants of Health and Their
Contribution to Premature Death
Social
circumstances15%
Environmental
exposure5%
Health care
10%
Behavioral
patterns40%
Genetic
predisposition30%
Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more
active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93.
Proportional Contribution to Premature Death
Population Health
David Kindig and Greg Stoddart. What Is Population Health? American Journal of Public
Health March 2003: Vol. 93, No. 3, pp. 380-383.
Triple Aim Populations
• Defined Populations: A defined population that makes
business sense (e.g. who pays, who provides) around the
Triple Aim
• Community-Wide Populations: Working in a geographic
area to accomplish the Triple Aim for the community
Triple Aim
Results
Defined Populations
Community-Wide
Populations
Population Management
DEFINITION
The design, delivery, coordination, and payment of services
for a defined group of people to achieve specified cost,
quality and health outcomes for that group of people.
Lewis, Ninon. "Populations, Population Health, and the Evolution of Population Management: Making Sense of the
Terminology in US Health Care Today." IHI Leadership Blog. Institute for Healthcare Improvement, 19 Mar. 2014.
Bring Down Health
Care Premiums
(1/1/11)
Payment Reform:
Affordable Care Act (ACA)
President Obama
signs the
Affordable Care
Act. (3/23/2010)
Prohibit Denying
Coverage of
Children Based on
Pre-Existing
Conditions
(9/23/2010)
Provide Free
Preventative Care
(9/23/2010)
Increase Access to
Services at Home
and in the
Community
(10/1/1/11)
Encouraging
Integrated Health
Systems &Launch
of ACO Pioneer
Program (1/1/12)
2010 2011 2012 2013 2014
Understanding and
Fighting Health
Disparities (3/1/12)
Improving
Preventative Health
Coverage & Launch
of SSP ACO model
(1/1/13)
Open Enrollment in
the Health Insurance
Marketplace Begins
(10/1/13)
Prohibiting
Discrimination Due
to Pre-Existing
Conditions or
Gender (1/1/14)
Establishing the
Health Insurance
Marketplace
(2014)
Source: U.S. Department of Health and Human Services
HHS to tie
90% of all
traditional
Medicare
payments to
quality or
value by 2018
ACO Growth Under the
Affordable Care Act
Source: Leavitt Partners Center for Accountable Care Intelligence
Serving over 18 million people
Accountable Care Organization (ACO)
DEFINITION
An ACO is an organization of health care providers that
agrees to be accountable for the overall care and cost of
care for assigned beneficiaries
Changing Healthcare Context
Fee for Service
Pay for Performance
Shared Savings
Shared RiskGlobal
Payment
Focus on IndividualsIndividuals and
PopulationsIndividuals, Populations
and Communities
Care Care and Cost The Triple Aim
Do to Do for Do WITH
An All Too Familiar ScenarioIt’s scary
when I
can’t
breathe.
Sometimes I’m
just too tired to
go to the
doctor.
I miss my
family.
An All Too Familiar Reaction
I know what
she needs,
but not how
to help her.
If only
someone
could
check on
her.
I don’t have the
time or the
resources.
Foundational Setup for Population
Management
1. Choose a relevant Population for improved health, care and lowered cost.
2. Identify and develop the Leadership and Governance for your effort.
3. Articulate a Purpose that will hold your stakeholders together.
Whittington, John, Kevin Nolan, Ninon Lewis, and Trissa Torres. "Pursuing the Triple Aim:
The First 7 Years." Milbank Quarterly 93.2 (2015): 263-300.
Delivery of Services at
Scale
Community, Family and Individual Resources
Managing Services for a Population
FeedbackLoops
Needs Assessment for
SegmentService Design
CoordinationGoals
Integrator
Population Segmentation
Population Outcomes
FeedbackLoops
Activities of a Population Management
Learning System
What Might Care Redesign Look Like?
EMS implements shared protocol to treat instead of
transport if appropriate
Care manager checks on her
regularly
Her son gets her a tablet and sets up Facetime
Physician’s office staff ask church members
to visit
How Might That Feel?32
My team
has
come
together.
I am thrilled
we are
helping Mrs.
Jones.
Her family, church,
and community
have all come
together to help
too.
Dr. Patel’s team
helps me.
I’m not
afraid.
I don’t feel
lonely
anymore.
Where to Start?Step 1: Identify Strategic Populations for Triple Aim Work
Foundational Setup for Population
Management
1. Choose a relevant Population for improved
health, care and lowered cost.
2. Identify and develop the Leadership and
Governance for your effort.
3. Articulate a Purpose that will hold your
stakeholders together.
Start with understanding the type of
population you will focus on:
Enrolled versus Community
Triple Aim Participant Populations
• Enrolled Populations: Enrolled populations are typically, a group of individuals receiving care within a health system, FQHC, or whose care is financed through a specific health insurance plan or entity
• Community-Wide Populations: Working in a geographic area to accomplish the Triple Aim for the community
Triple Aim
Results
Enrolled Populations
Community-Wide
Populations
Which Population Are You Choosing?
• Enrolled Populations
• Community-Wide Populations
• Please type in the chat window your population
of focus and how many individuals are in that
population
Enrolled Populations
“Enrolled populations are typically a group of individuals
who are receiving care within a health system or whose
care is financed through a specific health insurance plan or
entity.”
- Pursuing the Triple Aim: The First 7 Years ,Whittington, et al, The Milbank
Quarterly, Vol. 93, No. 2, 2015 (p. 267)
Considerations: Enrolled Populations
Is the leadership (CEO, executive team) of the
organization on board with the importance of
managing and supporting the Triple Aim or do
you have to make the case for this?
For health systems or other health
organizations: do you think that population
management is important for your future?
Community Populations
“Regional/community populations are population segments
defined geographically. Segments of a community
population are often unified by common needs or issues,
such as low-birth-weight babies or older adults with
complex needs. These individuals may receive care from a
variety of systems or may not be connected to care at all,
and they may or may not be insured.”
- Pursuing the Triple Aim: The First 7 Years ,Whittington, et al, The Milbank
Quarterly, Vol. 93, No. 2, 2015 (p. 267-268)
Considerations: Community Groups
Do you have a clear purpose on why this work is
important for the community?
Do you have the leadership in the community to support
this work?
What are the compelling reasons in your community to
form a coalition to work on the Triple Aim?
Who might serve in the convener role?
What health impacts are important in your community?
What stakeholders might benefit from cost savings from
healthcare?
Population and Sustainability
For the chosen Triple Aim population do you
have a sustainable funding stream/business
model to support your work?
Create a Purpose Statement
Purpose Statement: Why Devote Time, Resources, Money?
Your organization’s strategic purpose or return on investment (ROI) for focusing time and resources
on a Triple Aim Population.
Why are you pursing the Triple Aim?
Create a Purpose Statement
Articulates the specific and strategic WHY the work is
important
Message a compelling reason to focus resources on the
work-head and heart
Creates shared vision that helps to hold stakeholders
together through the challenges
Orients the improvement team/s work towards focused
impact
Key Points
Statements should be clear, compelling, and include what, why, and when
If this work is strategic this statement should outline why it is strategic for the organization
All Triple Aim activities should be connected to the purpose
Once the Purpose Statement is formed, it should be communicated to all leaders in the organization/coalition, such that all can clearly articulate it.
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Purpose Statement: Pueblo Triple Aim
Coalition (PTAC)
“Ever-rising healthcare spending weakens Pueblo’s local
economy, threatens jobs, and has failed to deliver improved
health of Pueblo County citizens. This combination of
increased costs and poor results threatens Pueblo’s future
by diverting resources from investment in education and
growth. The Pueblo Triple Aim Coalition (PTAC) formed to
respond to these issues. PTAC’s goals are to improve
health, reduce the per capita cost of care and improve the
experience of care in Pueblo County, otherwise known as
the ‘Triple Aim.’”
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Example Purpose Statement
“ABC Health Network, a clinically integrated network (CIN), is a
collaboration between local providers and ABC that creates
value for our community through integrated and efficient health
care. The Network is dedicated to creating exceptional patient
experiences, optimizing the health of community members,
improving quality outcomes and lowering the cost of care. We
recognize that developing a sustainable model of health care
delivery requires change. The Network is leading this change by
establishing a unique care delivery model that aligns provider
activities across the continuum of care and aligns incentives with
payors and patients to improve the health of the community.”
Example Purpose Statement
“We seek to improve access to / utilization of primary care
and behavioral healthcare services to vulnerable
children. We will strive to positively impact children’s health
by strengthening integrated models of care for our city’s
Public School students within school-based health centers
and at behavioral health clinics serving city Public School
students. We hope to be able to measure expenditures with
the goal of reducing the per capita cost of care.”
Chat in or Raise Your Hand
What are your organizations’ or
communities’ strategic driving needs to
work on the Triple Aim?
What is your business case to do this
work?
Where To Start?Step 2: Form a Triple Aim Team
Activities of a Population Management
Learning System54
Triple Aim Portfolio Team
Executive Sponsor
Portfolio Manager (100% FTE)
Measurement Lead
Content Expertise
Member with strong Quality Improvement Expertise
Other stakeholders-other leadership and clinical stakeholders in the organization
Community Partners
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Triple Aim Portfolio Team-Example56
Triple Aim Role Organizational Position
Executive Sponsor Executive Director, Population & Public Health / Addiction &
Mental Health
Portfolio Manager (100% FTE) Director, Clinical Quality Improvement
Measurement Leads Director, North Zone Analytics &
Executive Director, Addiction & Mental Health, Primary &
Community Care
Content Expertise Director, Addiction & Mental Health
Clinical Project Lead
Member with strong Quality
Improvement Expertise
(Acting) Director, Integrated Planning
Other stakeholders-other
leadership and clinical
stakeholders in the
organization
(as needed)
Information Technology Finance Clinical Informatics Communications
Community Partners None for this team
Pueblo Triple Aim Structure
High Level Policy and Governing Board: Pueblo Triple Aim
Corporation
– High Level Community Support
Advisory Council: Pueblo Triple Aim Steering Committee
– “Boots on the Ground”
Ad-Hoc Committees: Portfolio Specific
– Deal with shorter-term, single issue needs
Action Step: Purpose
Meet as a group and articulate areas of strategic importance for your organization to pursue the Triple Aim.
Write a purpose statement for your organization’s work in the Triple Aim.
Compose your core Triple Aim team if you have not already
Send your Purpose Statement and team composition to Julie Landsman at [email protected]
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Communication and Materials
A recording of this and all calls will be emailed to
you
Materials will be shared the day before each
session
Communicate to faculty and other participants
through our listserv: [email protected]
Pose questions, share resources, discuss barriers or
successes
– Email [email protected] if you or your colleague would like to
be added
– Primary enroller for your organization was automatically added
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Next Session
Session 2: Managing Populations
Wednesday March 9th, 2016
11:00 AM - 12:30 PM ET
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Poll62