Pursuing the Triple Aim

Written by the President and CEO of the Institute for Healthcare Improvement (IHI) and a leading health care journalist, this groundbreaking book examines how leading organizations in the United States are pursuing the Triple Aim—improving the individual experience of care, improving the health of populations, and reducing the per capita cost of care.

Even with major steps forward – including the Affordable Care Act and the creation of the Center for Medicare and Medicaid Innovation -- the national health care debate is too often poisoned by negativity. A quieter, more thoughtful, and vastly more constructive conversation continues among health care leaders and professionals throughout the country. Innovative solutions are being designed and implemented at the local level, and countless health care organizations are demonstrating breakthrough remedies to some of the toughest and most expensive challenges in health care.

Pursuing the Triple Aim shares compelling stories that are emerging in locations ranging from Pittsburgh to Seattle, from Boston to Oakland, focused on topics including improving quality and lowering costs in primary care; setting challenging goals to control chronic disease with notable outcomes; leveraging employer buying power to improve quality, reduce waste, and drive down cost; paying for care under an innovative contract that compensates for quality rather than quantity; and much more. The authors describe these innovations in detail, and show the way toward a health care system for the nation that improves the experience and quality of care while at the same time controlling costs.

As the Triple Aim moves from being largely an aspirational framework to something that communities all across the US can implement and learn from, its potential to become a touchstone for the work ahead has never been greater. Pursuing the Triple Aim lays out the vision, the interventions, and promising examples of success.

Preface vii

Acknowledgments xv

The Authors xix

1 HealthPartners 1

Care Model Process and Continuous Healing Relationships

2 Intel and Virginia Mason Medical Center 41

Marketplace Collaboratives for Better, Faster, More Affordable Care

3 CareOregon and Affiliated Clinics 85

Producing Health, Changing Lives

4 The Alternative Quality Contract 129

A Payment Method Supporting the Triple Aim

5 Bellin Health 167

Improving Population Health with the Right Care at the Right Place and the Right Cost

6 The Patient and Family Centered Care Methodology and Practice 199

Improving Patient Experience and Clinical Outcomes

7 Kaiser Permanente 231

Embedding Improvement Capacity into Organizational DNA

8 No Excuses 273

Effective Leadership to Achieve the Triple Aim

Epilogue 293

Innovation Everywhere

References 309

Index 315

To the patients and caregivers working to pursue the Triple Aim and to the amazing caregivers who support us all.

Maureen Bisognano is president and CEO of the Institute for Healthcare Improvement. She teaches at the Harvard School of Public Health and is an elected member of the Institute of Medicine.

Charles Kenney is the author of The Best Practice: How the New Quality Movement Is Transforming Medicine, and was awarded the 2012 Shingo Research and Professional Publication Award for Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience.

Advance Praise for Pursuing the Triple Aim

"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. This is storytelling at its best, and a must-read for those who are serious about providing top quality health care." —Lucian Leape, MD, Harvard School of Public Health

"If your life is dedicated to medical care you should read this book. It offers insight and evidence of what can be: vastly better medical care outcomes, patient and care giver satisfaction, and lower costs. This is not a utopian dream, it is the reality in a growing number of care giving institutions."—Paul O'Neill, former US Secretary of the Treasury

"I have never seen, nor had I dared hope to see, an era in American health care when transformational improvement is more possible than this moment. We have the templates. If you doubt it, I urge you to read this book. You'll learn about exciting innovations that are real, that are happening out there right now. And that can be replicated, with adaptation, anywhere. This book shows what health care looks like that delivers on our urgent social need for success on the Triple Aim: better care, better health, and lower cost through improvement."—Donald Berwick, MD, MPP, former president and CEO, IHI

Companion Web site: www.josseybass.com/go/bisognano