Do Doctors Care About the Triple Aim?

The stated goal of Patient Protection and Affordable Care Act (PPACA) (i.e. Obamacare) and healthcare reform is what people like to call the Triple Aim. For those not familiar with it, it goes as follows:

  • Improve patient satisfaction and quality of care
  • Improve the health of the community/population
  • Reduce the cost of healthcare.

I’ve regularly heard people reference the triple aim as a reason why we should act a certain way. They refer to the triple aim as the main goal of what we are doing with healthcare IT. It’s the unifying vision for which all of healthcare wants to achieve.

I’m here to tell you that it’s just not the case. There are plenty in healthcare that couldn’t care less about the triple aim of healthcare. Many in that group are doctors. Ok, maybe the word “care” isn’t the right one. They do care about patient satisfaction and quality of care. They do want the health of their community to be better. They do want the costs of healthcare reduced. They do care about those things, but do they care to the point where it will actually spur action?

Another way to look at this is do they care about the triple aim enough for them to change what they’re doing. Plus, do they care about other things more than the triple aim.

Let’s look at them backwards. Do doctors want to reduce the cost of healthcare? As citizens, of course they want the cost of healthcare reduced, but with one small caveat: As long as it doesn’t mean I get paid less. This isn’t a knock on doctors either. This is the perfectly rationale response to the idea of lowering costs in healthcare. It’s not something we should criticize. It’s something we should understand and apply to whatever we’re trying to achieve.

The same thing applies to improving the health of a community or population. Hopefully the shift to value based reimbursement, population health, and ACOs will help to realign the incentives to make it so doctors care more about this than they do now. Otherwise, many of these programs look like we’re asking our providers to provide more free work for the benefit of the community. Hard to blame them when you phrase it like that, no?

The majority of doctors embrace this first aspect of the triple aim. They really want to provide the very best care they can to the patients (with a few sad exceptions which give a bad name to the hundreds of thousands of doctors who are doing their best). The question I’d ask ourselves is are we putting doctors in a position where they can have satisfied patients who receive quality care or are we burdening our highest paid resource with tasks that don’t work towards this end goal? Every doctor I know would welcome the opportunity to have better satisfied patients and improved outcomes.

I love the components of the Triple Aim as an ideal, but as it is today I think there’s a misalignment between the ideal and the day to day reality for doctors. I’m not against being idealistic and ambitious in our goals. Although, don’t expect our healthcare system to reach the triple aim if we don’t realign the incentives. Plus, let’s not forget that not all incentives are financial.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

3 Comments

  • What you say is true and largely explains the growing discontent of physicians. Multiple surveys reveal that at least 40% of physicians are not just unhappy, but manifest symptoms of burn-out. Most of them have become complicit with systems where everyone is more focused on how to get paid more. The few healthcare delivery systems achieving on the Triple Aim and who have better physician satisfaction have almost all been blessed with physician leaders who step up to the challenge of collaboratively creating the necessary cultures focused on delivering value to patients. Value = Quality/Cost. This focus is necessary in order to produce not only the highest satisfaction but the greater financial rewards going forward. Again, doctors not operating at the top of their license and who have become distracted data drones are complicit with an increasingly corrupt system. The vast majority of physicians view that being able to be part of a quality process is more satisfying than the income received. So, those that are the happiest, and thriving the most are ones who are on a pleasing path to the Triple Aim.
    Sadly, the trends of the government-medical-industrial complex are increasingly filled with the hubris that value can be forced from the top-down via controlling algorithms into which patients and their doctors become data points to be plugged in and controlled.
    The degree of success we will see with any true healthcare reform will be the degree to which patients become more engaged and accountable. Those will need relationships with physicians deserving of their trust within healthcare delivery systems focused more on the value equation. Success simply has to come from the bottom-up, so this will force many true physicians to have to leave the more toxic delivery systems in some locales. They will be forced to either move or more directly interact with patients minus the misguided, controlling interference in their communities.

  • You both have it right.

    There are many moving parts but everyone trying to get paid more is at the core of the problem.

    I like the “Value (to patients) = Quality/Cost” formula.

    In principle, methodologies such as ACM and BPM are capable of driving healthcare in that direction but IMO the very strong focus on long term outcomes data collection causes healthcare professionals to operate as data trolls.

    ADM and BPM improve outcomes in many industry areas (manufacturing, services, insurance, law enforcement) – no reason why healthcare should be different.

    Important to point out that BPM (Business Process Management)on its own will not work for healthcare as it cannot accommodate users skipping steps, revisiting already committed steps, adding new steps, inserting steps not in the template, etc.

    BPM+ACM accommodates all manner of deviations away from what would otherwise be a rigid set of protocols.

  • Doctor always aims to improve patient satisfaction and quality of care and improve health of the community/population as a whole. But with Obamacare doctors are being pulled more into documentation rather than spending time with patient and providing quality care. Although it is not due to Obamacare, rather I would say due to EHRs built by technologist from the guideline provided by government without even considering workflow of doctor’s office. However, nowadays EHRs are taking help of physician and redesigning the workflow as per doctor’s need to survive in this competitive market. Only those EHRs will be able to survive in a long term and will help doctors to fulfill triple aim of Obamacare.

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