Value-Based Care

Balancing the Triple Aim and the Weight of Bias

Why the Triple Aim? Why not one or two? Why are all three critical, and why is each not significant enough on its own?

What happens when there isn't a simultaneous balanced focus on all objectives of the Triple Aim?


The Triple Aim framework emphasizes three crucial objectives improving patient experience, enhancing population health, and reducing the cost of healthcare ( →).

Extensive evidence and real-world experience demonstrate that neglecting any combination of the aims can lead to substantial challenges and imbalances within the healthcare system.

At HNI Healthcare, where our focus is on value-based care, understanding the importance of a holistic, unbiased approach to the Triple Aim is vital.


Improving the Patient Experience of Care:


Why is Patient Experience important?:

Improving the patient experience ensures care is patient-centered, respectful, and responsive. The goal is to enhance satisfaction, trust, and engagement in healthcare services, fostering effective communication between patients and healthcare professionals.

A positive patient experience is an important goal in its own right. Moreover, substantial evidence points to a positive association between various aspects of patient experience, such as good communication between providers and patients, and several important healthcare processes and outcomes. These processes and outcomes include patient adherence to medical advice, better clinical outcomes, improved patient safety practices, and lower utilization of unnecessary healthcare services. ( →)


What if we don’t focus on Patient Experience?:

Neglecting patient experience may lead to dissatisfaction, non-compliance, and reluctance to seek timely care, impacting health outcomes. Poor communication and lack of empathy can erode trust between patients and providers.

Unfortunately, the negative experiences can have a lasting impact, as 44% of people reporting these negative experiences said they felt stressed or upset by them. About one-third of this group said they switched providers or treatment and were less likely to seek care the next time they needed it. ( →)


What if we only focused on Patient Experience?

Focusing solely on patient experience might lead to overutilization of services to meet individual demands, driving up costs. Additionally, ignoring population health and cost control can strain resources, affecting overall healthcare sustainability.

In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality. (Cost of Satisfaction →)


What if we only focused on Population Health and Cost Reduction?

If patient experience is ignored while focusing on population health and cost reduction, patient dissatisfaction and distrust may occur. Even with improved overall health and reduced costs, the lack of a patient-centered approach can lead to a breakdown in the doctor-patient relationship.

Colleagues found that overall satisfaction with care is positively correlated with clinical adherence to treatment guidelines. (Patient Experience →)


Improving the Health of Populations:


Why is Population Health important?:

Improving population health involves preventive measures, health education, and addressing social determinants. The goal is to reduce diseases, promote healthier lifestyles, and create thriving communities.

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. ( →)


What if we don’t focus on Population Health?:

Neglecting population health leads to a higher prevalence of preventable diseases, increased demand for healthcare services, and strained resources. Communities suffer due to the lack of preventive care and health education.

America's health status does not match the nation's substantial health investments. The work of assuring the nation's health also faces dramatic change, systemic problems, and challenging societal norms and influences. Given these issues, the committee believes that it is necessary to transform national health policy, which traditionally has been grounded in a concern for personal health services and biomedical research that benefits the individual. ( →)


What if we only focused on Population Health?

Focusing solely on population health might lead to overlooking individual patient needs and preferences, resulting in dissatisfaction and potential non-compliance. Additionally, ignoring cost control can lead to financial strain on healthcare systems.

Rose (1981) termed the preventive approach the “prevention paradox” because it brings large benefits to the community but offers little to each participating individual. ( →)


What if we only focused on Patient Experience and Cost Reduction?

If population health is ignored while focusing on patient experience and cost reduction, the community's overall health may suffer. Preventive measures and health promotion efforts might be insufficient, leading to increased disease burden.

“medical thinking has been largely concerned with the needs of sick individuals.” Although this reflects an important mission for medicine and health care, it is a limited one that does little to prevent people from becoming sick in the first place, and it typically has disregarded issues related to disparities in access to and quality of preventive and treatment services. (  →)


Reducing the Per Capita Cost of Healthcare:


Why is Reducing Cost important?:

Reducing costs ensures healthcare services are affordable and accessible. The goal is to optimize resource utilization, eliminate waste, and promote efficiency without compromising the quality of care.

Walmart wasn’t providing this benefit out of the goodness of its corporate heart, of course. It was hoping that employees would get better surgical results, sure, but also that the company would save money. Spine, heart, and transplant procedures are among the most expensive in medicine, running from tens of thousands to hundreds of thousands of dollars. Nationwide, we spend more money on spinal fusions, for instance, than on any other operation—thirteen billion dollars in 2011. And if there are complications the costs of the procedure go up further. The medical and disability costs can be enormous, especially if an employee is left permanently unable to return to work. These six centers had notably low complication rates and provided Walmart a fixed, package price.

Two years into the program, an unexpected pattern is emerging: the biggest savings and improvements in care are coming from avoiding procedures that shouldn’t be done in the first place. Before the participating hospitals operate, their doctors conduct their own evaluation. And, according to Sally Welborn, the senior vice-president for benefits at Walmart, those doctors are finding that around thirty per cent of the spinal procedures that employees were told they needed are inappropriate. Dr. Charles Nussbaum, until recently the head of neurosurgery at Virginia Mason Medical Center, confirmed that large numbers of the patients sent to his hospital for spine surgery do not meet its criteria. (Overkill →)


What if we don’t focus on Reducing Cost?:

Neglecting cost reduction leads to escalating healthcare expenses, limiting access to essential treatments, and burdening both individuals and healthcare systems financially.

What explained this? Our piecework payment system—rewarding doctors for the quantity of care provided, regardless of the results—was a key factor. The system gives ample reward for overtreatment and no reward for eliminating it. But these inducements applied everywhere. Why did McAllen succumb to them more than other medical communities did? Doctors there described a profit-maximizing medical culture. Specialists not only made money from the services they provided; many also owned stakes in home-health-care agencies, surgery and imaging centers, and the local for-profit hospital, which brought them even bigger returns from health-care overuse. (Overkill →)


What if we only focused on Reducing Cost?

Focusing solely on cost reduction might compromise patient experience and population health. Quality of care might decline, leading to dissatisfaction and potential health disparities within communities.

The main way we’ve tried to stop unnecessary treatments has been through policing by insurers: they could refuse to pay for anything that looked like inappropriate care, whether it was an emergency-room visit, an MRI scan, or an operation. And it worked. During the nineteen-nineties, the “Mother, may I?” strategy flattened health-care costs. But it also provoked a backlash. Faceless corporate bureaucrats second-guessing medical decisions from afar created an infuriating amount of hassle for physicians and patients trying to orchestrate necessary care—and sometimes led to outrageous mistakes. Insurance executives were accused of killing people. Facing a public outcry, they backed off, and health-care costs resumed their climb. A decade and a half later, however, more interesting approaches have emerged. (Overkill →)


What if we only focused on Patient Experience and Population Health?

If cost reduction is ignored while focusing on patient experience and population health, healthcare services might become financially unsustainable. Access to essential treatments could be limited, affecting both individual patients and community health.

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. (Overkill →)


In any of these scenarios, a biased approach could lead to a healthcare system that lacks harmony.

By simultaneously addressing these three objectives, the Triple Aim framework seeks to create a healthcare system that is not only patient-centered but also efficient, effective, and sustainable, leading to better outcomes for both individual patients and entire populations.

We want to advocate for a healthcare system where interventions are meaningful, necessary, and improve both individual patient experiences and overall population health while controlling costs.

We believe we can create a healthcare ecosystem where quality, accessibility, and affordability converge, ultimately ensuring better outcomes for patients and communities alike. Let us strive together to achieve this delicate equilibrium and transform healthcare for the better. 


What does healthcare waste look like?

hni healthcare waste calculator

Understanding the 25% of Healthcare Spending Estimated to be Waste →

25% of the $4.1 trillion spent on healthcare is waste. How value-based care creates a more viable future. Healthcare waste is defined as “medical services that provide little or no benefit to the consumer, or as avoidable overspending on services that could be more efficiently delivered...

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