This document discusses the Triple Aim framework for healthcare systems put forth by the Institute for Healthcare Improvement. The Triple Aim aims to simultaneously improve patient experience of care, improve population health, and reduce per capita healthcare costs. Examples are provided from community health centers in the US that have successfully implemented initiatives addressing all three aims, such as comprehensive social services programs, risk-stratified patient care management, and value-based payment models. The presentation concludes by encouraging Canadian community health centers to apply the principles of the Triple Aim through data-driven innovation, patient engagement, local partnerships, and continuous quality improvement efforts.

1. Ron Yee, MD, MBA, FAAFP
Senior VP, Clinical Affairs Division
Chief Medical Officer
“Triple Aim in Healthcare: Strategic Role of CHCs”

2. Agenda
• Institute for Healthcare Improvement (IHI)
Triple Aim Background
• Examples from the United States
1. Improving the patient experience of care
2. Improving the health of populations
3. Reducing the per capita cost of care
4. Bringing it all together
• How Do We Do This in Canada?

3. IHI Triple Aim
• Framework to describe an approach to optimize health
system performance
• All three elements must be pursued simultaneously
• Why? The US health care system is the most costly in the
world with 17% of GDP spending, going to 20+% by 2020
• IHI move from “What’s the matter?” medicine to
“What matters to you?” medicine
• 90-day harvest cycles of innovation since 2006
• 5,000 hour example; improving patient outcomes
• What matters to patients, assess assets, create new
systems to provide care

4. IHI Triple Aim
http://www.ihi.org/Engage/Initiatives/TripleAim/Documents/ConceptDesign.pdf

5. Improving Patient Experience of Care
Patient Engagement Toolkit
• Patient Advisory Councils
• How to create, training
• Patient Experience Survey
• Patient portals
• CAHPS, aligned with NCQA
19 key requirements
• Social Determinants of Health
• Barrier & asset mapping
• 20 Domains
• Clinical metrics c/w HP2020
• HTN, DM, Cx CA, Tobacco,
BMI
http://cchn.org

6. • Comprehensive
approach to SDH
• Medical care and social
services integration
• ESL, vocational training,
legal services, housing,
community gardens,
microcredit loans for
women entrepreneurs,
SA recovery
• Close community ties
• 28 culturally diverse
populations served
Improving Population Health
La Maestra Circle of Care
http://www.lamaestra.org/circle-of-care/default.html

7. Decreasing Per Capita Cost/Value
http://www.elrio.org
• Founded in 1970, 6 primary sites
• “Best Practice” Pharmacy-based DM
Management program (6 nationally),
Innovative Research Award, NACHC
• Worked with payer who provided ER
and IP daily discharge data
• Risk stratified patient reports & action
• Over 2 years
• Addressed high risk patients
• Transitions of care, 7D f/u
• Reduced non-emergent ER-41%
• Reduced avoidable admits-25%
• Increased membership by 52%
• Split savings $4M

8. Bringing it All Together
• Serving Southern California for
over 45 years
• Birth through elder care, 43 sites,
930,000 visits a year
• Primary medical, dental, senior
long-term care, SA, HIV/AIDS,
BH, Chronic Care, Pharmacy, etc.
• Owns own IPA/MC network
• Highest 2014 Quality Award
winner in California; $259,132 of
incentives awarded
• PCMH, Pt. Safety, HEDIS metrics,
Evidence-based practices
• Blended Triple Aim objectives
http://www.altamed.org

9. How Do We Do This In Canada?
• Get started!
• Optimize existing data – know and use your data
• Engage and listen to your patients – they know best!
• Be creative and innovate more efficient and cost
effective approaches to patient care
• Look for local partners and mutual benefit
• Document small wins & successes and celebrate
• Do friendly comparisons – with self and others
• Share successful models and continuously improve
• Fulfill the Triple Aim!

10. Ron Yee, MD, MBA, FAAFP
Senior VP, Clinical Affairs Division
Chief Medical Officer
“Triple Aim in Healthcare: Strategic Role of CHCs”