Paper on Impact of Implementing Triple Aim Goals Nationally

Identifying a Relevant Population

In order to achieve sustainable improvement, organizations were encouraged at the outset to choose a population or populations for

which all 3 dimensions of the Triple Aim were important. In the early days of our work, organizations often chose a population for which only 2 dimensions of the Triple Aim made sense, with the most likely weakness being per capita cost. Even though these organizations saw the value of improving health and care for the population, their payment model did not reward them for lower per capita cost. In some cases, the payment model actually penalized them when they improved health because it led to less need for health care and, consequently, less revenue.

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Some organizations chose their own employees as their relevant population, which improved the employees’ health and created a better care experience for them while also reducing health care costs for both employer and employees. For regional coalitions, finding opportunities to improve health and care was typically straightforward, but it often proved more challenging to build a community-wide financing model for this same population. Some community partners, for example, made less money when the population’s health improved. In one community, a health care leader (who asked to remain anonymous) described a health system CEO who encouraged his employees to participate in a coalition working on a regional Triple Aim initiative with the goal of slowing down the improvement process. His reason was that the hospital would face financial risk if the Triple Aim succeeded, and he might have been correct, given the existing payment model at that time. This example illustrates the potential political tensions at the community level that need to be considered, along with other issues, when selecting populations of focus for the Triple Aim.