As we continue to analyze key elements of the evolving healthcare landscape, our next series of blog posts will discuss payers’ and health systems’ approaches to achieving the Quadruple Aim of health system performance.
WHAT IS THE QUADRUPLE AIM?
The Quadruple Aim is an extension of the Triple Aim concept developed in 2004 by the Institute for Healthcare Improvement (IHI). The IHI developed a framework to optimize health system performance based on three specific objectives:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
Recently, a new pillar – Care Team Well-being – has been added to the Triple Aim concept to address the widespread burnout and dissatisfaction among physicians and other healthcare professionals. This post will discuss the first pillar – Improving the Patient Experience of Care.
THE PATIENT EXPERIENCE AND HEALTH SYSTEMS
There are a number of different interpretations of “the patient experience of care.” The Agency for Healthcare Research and Quality (AHRQ) defines it as “the range of interactions that patients have with the healthcare system, including their care from health plans, and from doctors, nurses, staff in hospitals, physician practices, and other healthcare facilities.” As the patient experience is operationalized in the health system environment, there are generally two paths taken.
The first path is an interpretation of the patient experience that closely aligns with key quality improvement domains; specifically, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In this approach, health systems are intensely focused on prioritizing the relationships and touch-points along the patient’s care journey that will result in improvement in these quality domains, not the total patient experience.
The second path is a broad interpretation of the patient experience that focuses on bringing hospitality to healthcare. As part of this approach, many health systems seek to develop meaningful relationships with patients and families, working to create a patient-centric environment that will result in an optimal patient experience. Health systems that place great importance on hospitality do so based on their belief that improved patient experiences naturally lead to improved outcomes, which will correlate to a number of quality improvement domains.
Regardless of the approach health systems take, the overarching success factor in improving the health system patient experience is communication. Specifically, their main priority is to standardize communication at the individual and team level, so the care team demonstrates empathy and patients have a better understanding of their care. While this methodology may seem obvious and eminently feasible, many factors prevent such standardization.
THE PATIENT EXPERIENCE AND PAYERS
Given that 18% of the US gross domestic product (over 3.2T) is spent on healthcare, current transformation efforts cannot be successful without accompanying payment reforms. A key component of payer reform is the inclusion of those accountable for the healthcare spend. Many health plans are seeing a significant shift of cost sharing to members (patients) as an increasing number of plans offer benefits that include: high deductibles, rising copays/co-insurance, and health savings accounts. To ensure health plan members (patients) are empowered and engaged in their healthcare spending, many payers have initiated transparency efforts, including:
- Cost Transparency – publishing cost calculators for their members (patients), allowing them to see the differences in costs for similar services in their community
- Quality Transparency – publishing star or quality rankings based on provider performance in certain quality indicators, such as preventive care and chronic disease management
- Member (Patient) Incentives – providing rewards for choosing a lower cost commodity or service
Healthcare reform cannot be successful without payment reform.
These and other efforts toward greater transparency serve to strengthen the member (patient) experience and help patients spend wisely, in line with their own preferences. While it is yet unknown whether there are unintended consequences behind these efforts to improve the member (patient) experience, one thing is clear – healthcare reform cannot be successful without payment reform.
THE PATIENT EXPERIENCE AND LIFE SCIENCE
Life science and organized customers are major stakeholders equally dedicated to improving the patient experience. In addition to being fully invested in improved care, their relationship is both self-sustaining and mutually beneficial. Organized customers benefit from the extensive patient behavior research conducted by life sciences organizations, while life science can expect a steady increase in demand for their research to inform the optimization of patient care. With shared goals and highly targeted data, life science and organized customers are addressing the patient experience to ensure the right patient gets the right therapy at the right time.
The next post in this series will explore the second objective of the Quadruple Aim – Improving the Health of Populations.