Triple Aim: Improving the patient healthcare and experience

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Alan Neil
Alan Neil

For patients in a participating ACO (Accountable Care Organization) or PCMH (Patient Centered Medical Home) one of the initial improvements will be the assignment of a care manager to guide and support them through the ACO experience. The care manager may be a Triple Aim committed primary care physician or ACO professional who takes responsibility for coordinating care plans. They will assure the patient receives and participates/understands the appropriate level of care at the appropriate level facility and that patient history is available at all levels through committed creation and maintenance of Electronic Medical Records.

Assignment of a care manager available to discuss health issues encourages less use of the ER for non-emergency conditions. Patients in the ACO are encouraged to use the case manager as first contact and the case manager councils and explains current conditions and when and where to go for treatment. If treatment is hospital based outpatient follow-up is encouraged to reduce the need for readmission or ER visits for routine issues. Patients in ACO systems receive more detailed explanations of what to expect and clear and concise instructions of where to go under what circumstances. Increased understanding of their healthcare goals and directions is expected to lead to higher levels of patient satisfaction, less anxiety and reduce time wasted seeking answers to health-related issues.

ACO organizations pledge to use only science-based treatment modalities with known outcome performance. For the wound care patient, that means understanding Advanced Wound Care modalities, such as moist wound healing dressings, can lead to faster wound healing when compared to non-science based treatments such as wet to dry gauze. Switching from wet gauze dressings in the hospital to dressing change every 2 to 5 days at home provides a significant treatment cost reduction for the ACO and a superior healthcare experience and quality of life for the patient. Science-based treatments in the ACO system mean each patient enters treatment protocols with known healing trajectories and that those not responding to first line treatments are quickly identified and provided with additional and more aggressive science-based protocols. Science-based treatment modalities are expected to provide the best treatment experience for individuals. Results are to be documented and compared to those previously obtained or those experienced by Non-Triple Aim Centered organizations.

A key component of the ACO / Triple Aim experience is the demonstration of improved outcomes for each patient and the ACO population as a whole. Adoption of Electronic Medical Records (EMR) is a required and significant part of the Triple Aim Process to document improved success due to changes in practice. Over time, patient EMRs accumulate individual health issues, treatments and outcomes and allow care managers and all QHPs to present a logical science based bundle of individually tailored management decisions. Better documentation of outcomes and comparison to outcomes under anecdotal treatment scenarios can show which processes bring the highest outcomes and best patient satisfaction to those receiving care. The patient has the confidence of knowing they are part of a well-organized provider group with defined goals of insuring the best possible outcomes and patient experience. Documentation of improved outcomes also benefits the ACO as part of the savings are shared with the organization to encourage outcomes versus pay per procedure.

The ability to address prevention in a coordinated and dynamic manner represents another care improvement to be expected when the commitment to Triple Aim is accomplished. As payment shifts from pay-for-services to pay-for-outcomes, the ACOs benefit from encouraging early recognition of health issues, early intervention and efforts to modify individual behavior towards recognition and acknowledgement of lifestyle changes that help improve general health and reduce the incidence and effects of poor health choices. For example, patients with family history or early signs of venous disease can be educated on the absolute necessity of compression to avoid and manage venous leg ulcers. Diabetic patients can have their insulin needs explained and supported across all sites of treatment and ulcers can be identified, treated and resolved early before they become life threatening chronic ulcers.

ACOs are encouraged to improve patient behavior to reduce incidence and also to detect wounds earlier when they are most responsive to science based treatment protocols and dressings. Patients should benefit through faster healing, less pain and social interruption, fewer amputations and better quality of life while reducing costs to payers.

In conclusion, for each individual at risk for chronic wounds there will be:

  • Better overall state of health
  • Awareness of risk factors and counseling on beneficial behavior changes affecting the risk of developing wounds
  • Early detection
  1.             Smaller wounds
  2.             Less opportunity for infection,
  3.             Less inflammation
  • Science based treatments
  1.             Avoid traditional Gauze tid
  2.             Early utilization of advanced wound care
  3.             Fewer dressing changes
  • Less Pain
  1.             Early progression to higher level treatments only if required
  • Selection of appropriate level facility
  1.             Less hospital
  2.             More outpatient and homecare
  3.             EMS documentation of outcomes
  4.             Adoption of the most successful treatment strategies
  • Care Manager assurance of follow-up and adherence
  1.             Strategies for prevention
  2.             Strategies to prevent recurrence
  • Improved quality of life over multiple dimensions.
Alan Neil is the founder and CEO of ASN Associates.
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