According to the CMS National Healthcare Expenditure Projections report, the U. S. healthcare system is the most expensive in the world, making up 17% of the country’s gross domestic product. Projections have that number reaching to nearly 20% by 2020. Aging populations combined with chronic health problems have put an enormous strain on medical and social services.
The reality is our healthcare system is broken. The way it’s constructed makes it difficult to navigate – for patients, providers, and employers. The good news is that visionary leaders and organizations are embracing change in an attempt to make a meaningful difference. That’s important because we should not be handing over the healthcare delivery system we’ve created to future generations. But instead of pointing fingers or assessing blame, we should be working together to make needed changes.
At Marathon Health, we’re doing everything we can to improve the overall system by being advocates for our patients and offering what we believe is a different vision of healthcare. As an operator of on-site workplace centers in 39 states, we are focused on total population health management. We work with companies to make sure their employees are receiving the right care at the right time from the right provider to put them on a path to health and wellness.
Triple/Quadruple Aim Initiative
Strides are being made in the healthcare industry, but in our view improvement is impossible as long as the system is driven by the utilization incentives of a fee-for-service transactional model. The shift to value-based care is crucial to improving the system. One of the most exciting frameworks to support such a results-based model is the Triple Aim Initiative developed by the Institute for Healthcare Improvement (IHI). Triple Aim focuses on three key areas:
The Patient Experience – Patients should be getting care and concern like they’ve never felt before as opposed to being treated like an encounter only.
Healthcare outcomes – Organizations should be striving to make demonstrable progress in specific healthcare outcomes to increase the health of the population. The focus needs to be on preventative rather than reactive care.
Per capita spend – Patients must be part of the equation and included as much as possible in decisions involving their care. That will make a significant impact in lowering the overall healthcare cost for patients, providers, and insurers.
To achieve these three goals requires adding a fourth aim - providing clinicians the best possible working environment and job experience. Expanding the Triple Aim into the Quadruple Aim focuses on making the lives of clinicians easier and more rewarding through effective use of technologies, supportive behaviors, and a nurturing culture. This enables them to realize the goals they set when they pursued medical school in the first place – to practice and focus on the care and concern of their patients.
Setting Up an Enabling Culture
Culture is the key to the fourth aim. Establishing a supportive environment enhances the attitude of clinicians, making them feel like they’re doing the job they were trained to do. Developing this nurturing culture can drive substantive results. Instead of job-hopping because the system keeps beating them down, clinicians become energized and in turn can achieve dramatic results in all aspects of care giving.
There are two aspects to providing an enabling culture: community and rigor.
Establishing community outreach starts with one underlying message: This is your health and we’re here to help you make the best of it. Driving this message means not simply being directive, but instead working collaboratively with patients to help them reach their goals.
Rigor is the other crucial half to developing the right culture. Six Sigma, Korn Ferry competency models, Kaizen, setting up and measuring KPI’s, and establishing an atmosphere of continuous process improvement are critical building blocks for a results-driven organization. Creating a successful program requires a relentless pursuit of excellence anchored by defined goals and measurable results.
Driving Success in Practice
There are three key points to making the Quadruple Aim work in practice: engagement, technology, and efficacy.
Allowing clinicians to practice in a supportive culture enables them to engage patients in a different way than ever before. Instead of an impersonal, time-sensitive transaction, primary care physicians may begin an engagement by asking a patient, “What are you passionate about?” The focus should be on meeting the patient where they are so the clinician can actually understand the long term needs of each patient. Creating an experience that has the patient walking away thinking they’ve been heard and cared for.
Healthcare technology needs to enable clinicians instead of handcuffing or frustrating them. It should give them all the tools they need to focus on the holistic care of the individual patient. They shouldn’t be bogged down in paperwork or key clacking, but instead must be given the time to better service patients.
Ultimately, the results must be there. Freeing clinicians to practice results in changing prevalence rates by condition, lowering the actual risk profiles of segments of the population, and lowering the percentage of people that are in the risk category. By reducing and mitigating risk, you’re actually achieving the goals of Triple Aim. The patient is satisfied, health outcomes are improving in demonstrable, reportable fashion by defined categories, and costs are driven down.
More than Theory
Implementing this program has driven positive, actual results for many of our partners. Depending on risk category, anywhere from 16 to 59 percent of employees have improved on a wide array of risk factors. Year over year medical claims have leveled off or been reduced by anywhere from four percent in year one to almost nine percent in year five.
The financial results are just as impressive. One U. S. academic medical center has achieved cumulative net savings of nearly $2 million in 18 months. A northeastern U. S. apparel manufacturer has saved $2.73 million in four years.
We have willingly shared our methodology with other healthcare organizations because we understand it’s not about Marathon, but is about improving the healthcare system in our country. We are receptive to anyone who wants to partner with us to make necessary improvements.
Care for your Clinicians
The primary key to succeeding with Quadruple Aim is making sure you are working to improve the experience of your clinicians. One of our initiatives is the Clinician Excitement Project. Excited clinicians can unleash the passion of those people who want to care for their patients free of as many limitations as possible and that can make all the difference in the world. That type of attitude can spark the kind of healthcare revolution that we need in this country. Care for your clinicians and make sure you’re giving them the tools, the support, and the streamlined workflow they need to do their jobs well. If we all make this a primary focus, they’ll be more productive and efficient, and patients will receive better care. In the end everybody wins.
By Jerry Ford, CEO, Marathon Health
For more information on strategic thinking and the transition away from fee-for-service, feel free to download our White Paper: The Shift to Value-Based Care: 9 Steps to Readiness
 IHI Triple Aim Initiative, Institute for Healthcare Improvement website