Triple Aim© Video Discussion Guide

Understanding and Facilitating Rural Health Transformation

Introduction

Delivering health care value in rural communities is an increasingly important health care system responsibility. Health care value can be defined by the Triple Aim©:

• Better patient experience (both clinical quality and patient satisfaction)
• Improved community and population health
• Reduced cost of care

Objectives

This Triple Aim© Video Discussion Guide will inform and stimulate discussion in your rural community and help viewers:

• Understand the definition of health care value
• Recognize how a shift to health care value will impact local health care providers
• Identify opportunities to increase health care value
• Provide a rural context for implementing the Triple Aim©

Participants

Engaging a broad variety of stakeholders in discussions about how to improve health care value will help develop understanding, gain support, and generate creative solutions to fit your community's needs. Groups to consider include:

• Health Care
  • Medical and nursing staff
  • Hospital Department Heads
  • Nursing Home/Assisted Living Directors
  • Home Care/Hospice Directors
  • Clinic Managers
  • Behavioral Health Clinics/Providers
• Social Service
  • Local government social service leaders
  • Faith-based organizations
  • Public Health agencies
  • Home Health agencies
  • Free clinics or other providers
• Community
  • Health Care Boards of Directors
  • Chamber of Commerce
  • Large Employers
  • Community/Service Agencies

Discussion Questions

1. How health care providers are paid is often not clear to patients. What would our patients, families, and community say about being rewarded to deliver the Triple Aim©, and why?
2. Before an organization can improve health care value, value must be measured. What indices of health care value are being measured now, and what indices should be measured going forward?
3. Currently, most health care providers are paid based on volume of services provided. What challenges will health care providers face as payment shifts to health care value, not volume?
4. In the near future, health care providers will continue to be primarily paid based on volume of services. What strategies might be implemented to "test the waters" of value-based care that are of relatively low financial risk?
5. Delivering the Triple Aim© requires coordination of care. What obstacles currently exist to care coordination and how can those barriers be broken? What barriers are unique to rural providers?
6. The saying "It takes a village" has been invoked when comprehensive change is needed. What community strengths, resources, and capacities can be utilized to improve local health care value?

Triple Aim© Resources

• Institute for Healthcare Improvement Triple Aim© website.
  The website defines the Triple Aim© and the Institute's innovation team describes a concept design and an initial set of components of a system that would fulfill the Triple Aim©. The website includes a 7-minute video that describes design of a Triple Aim© Enterprise.
• Berwick, Nolan, and Whittington. The Triple Aim©: Care, Health, and Cost.
  Abstract: Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.
• McCarthy and Klein. The Triple Aim© Journey: Improving Population Health and Patients' Experience of Care, While Reducing Costs.
  Abstract: Case studies of three organizations participating in the Institute for Healthcare Improvement's Triple Aim© initiative shed light on how they are partnering with providers and organizing care to improve the health of a population and patients' experience of care while lowering - or at least reducing the rate of increase in - the per capita cost of care.
• Bisognano and Kenney. Pursuing the Triple Aim©: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs. 2012. ISBN-13: 978-1118205723.
  "Clear and focused, with a wealth of insights into how health care organizations have reinvented themselves to achieve unprecedented levels of quality, efficiency, and patient experience." - Lucian Leape, MD, Harvard School of Public Health

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