IHI Virtual Expedition:Kick-Start the Triple AimSession 1: Set-up for Pursuing the Triple Aim

February 24, 2016

Begins at 11:00 AM ET

Matt Guy, MPACory Sevin, RN, MSN, NP

Today’s Host

Julie Landsman is a Project Coordinator with the Institute for Healthcare Improvement. She works with the Building Capability Group coordinating web-based offerings, as well as with the IHI Open School on video resources and course development. Julie graduated from Northeastern University in Boston, MA where she received a Bachelor of Arts Degree in Sociology with a focus in International Affairs.

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Goal of Series

Leverage a robust framework and guiding principles to

better manage populations towards the Triple Aim

Establish the governance, learning, and execution

infrastructure at all levels of your system

Manage and measure progress for a portfolio of system-

level projects

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Expedition Activities

5 90-minute webinars

Faculty:

– Matt Guy, MPA

– Kevin Nolan, Mstat

– Cory Sevin, RN, MSN

Focused Action Steps between webinars

All Teach, All Learn-drawing on your experiences

as you work with the action steps.

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Kick Start Call Topics

1. Set-up for Pursuing the Triple Aim – February 24th

2. Managing Populations – March 9th

3. Governance, Leadership, and Sustainability –

March 30th

4. Managing Services for Population and Portfolio

Management – April 13th

5. Triple Aim Measurement and Learning System –

April 27th

All calls from 11:00 AM - 12:30 PM ET

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Expedition Faculty11

Matthew Guy, MPA, is the Managing Director of the Pueblo

Triple Aim Corporation (PTAC). He recently served as

Executive Director of the Southeastern Colorado Area Health

Education Center (SECAHEC). SECAHEC serves 16 counties

in southeastern Colorado providing health education resources

and support for current and future medical professionals. Matt

has also worked for the Colorado Rural Health Center working

with safety net and rural health clinics in Southeastern

Colorado to improve the quality and effectiveness of their

practices. He has served as the 3rd Congressional District

representative on the Colorado Commission on Family

Medicine and works as a consultant with the Colorado Rural

Health Center, American Medical Association, and other

organizations in the areas of practice improvement and

community health needs assessments. Matt received his BA

from Central College (Iowa), has a master’s degree in Public

Administration from the University of Colorado, holds a 4th-

degree black belt in taekwondo, and is Commissioned Lay

Pastor with the Presbyterian Church USA in the Pueblo

Presbytery.

Expedition Director12

Cory B. Sevin, RN, MSN, NP, is a director with the

Institute for Healthcare Improvement. With IHI, she has

led work in spread, redesigning the clinical office

practice, improving transitions into home healthcare,

improving emergency department flow, and improving

transitions in care to reduce readmissions. Sevin is a

nurse practitioner with a clinical specialty in

adolescent, preventative and community health. Past

experience includes 26 years working in a variety of

community settings, including public health, schools,

and community health centers. Before coming to IHI,

she was vice president of operations at Clinica

Campesina, a community health center in Lafayette,

Colorado. She received her BSN in 1976 from the

University of Michigan and her MSN in 1980 from the

University of Cincinnati.

And You?13

Today’s Objectives:

Set-up for Pursuing the Triple Aim

Describe the IHI Triple Aim.

Identify strategic and financial reasons to pursue

the Triple Aim.

Identify key elements necessary for an aligned,

system-wide, strategic purpose for the Triple

Aim.

List team roles for a team within an organization

pursuing the IHI Triple Aim.

Polling Question

Our organizations long-term success depends on

attaining better health, better care experience and lower

per capita cost for specific populations we serve and our

strategy states it explicitly

Our strategy includes mention of better health, care

experience and per capita cost for specific populations

but these are not explicit goals.

Our board and senior leadership has discussed the

implications of the Triple Aim and we are beginning to

incorporate these ideas into our strategy

Our current strategy is not tied to the Triple Aim

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Definition of Terms

Triple Aim

Population Health

Population Management

Payment Reform

Definition

System designs that simultaneously improve three

dimensions:

– Improving the health of the populations;

– Improving the patient experience of care (including quality and

satisfaction); and

– Reducing the per capita cost of health care.

Determinants of Health and Their

Contribution to Premature Death

Social

circumstances15%

Environmental

exposure5%

Health care

10%

Behavioral

patterns40%

Genetic

predisposition30%

Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more

active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93.

Proportional Contribution to Premature Death

Population Health

David Kindig and Greg Stoddart. What Is Population Health? American Journal of Public

Health March 2003: Vol. 93, No. 3, pp. 380-383.

Triple Aim Populations

• Defined Populations: A defined population that makes

business sense (e.g. who pays, who provides) around the

Triple Aim

• Community-Wide Populations: Working in a geographic

area to accomplish the Triple Aim for the community

Triple Aim

Results

Defined Populations

Community-Wide

Populations

Population Management

DEFINITION

The design, delivery, coordination, and payment of services

for a defined group of people to achieve specified cost,

quality and health outcomes for that group of people.

Lewis, Ninon. "Populations, Population Health, and the Evolution of Population Management: Making Sense of the

Terminology in US Health Care Today." IHI Leadership Blog. Institute for Healthcare Improvement, 19 Mar. 2014.

Bring Down Health

Care Premiums

(1/1/11)

Payment Reform:

Affordable Care Act (ACA)

President Obama

signs the

Affordable Care

Act. (3/23/2010)

Prohibit Denying

Coverage of

Children Based on

Pre-Existing

Conditions

(9/23/2010)

Provide Free

Preventative Care

(9/23/2010)

Increase Access to

Services at Home

and in the

Community

(10/1/1/11)

Encouraging

Integrated Health

Systems &Launch

of ACO Pioneer

Program (1/1/12)

2010 2011 2012 2013 2014

Understanding and

Fighting Health

Disparities (3/1/12)

Improving

Preventative Health

Coverage & Launch

of SSP ACO model

(1/1/13)

Open Enrollment in

the Health Insurance

Marketplace Begins

(10/1/13)

Prohibiting

Discrimination Due

to Pre-Existing

Conditions or

Gender (1/1/14)

Establishing the

Health Insurance

Marketplace

(2014)

Source: U.S. Department of Health and Human Services

HHS to tie

90% of all

traditional

Medicare

payments to

quality or

value by 2018

ACO Growth Under the

Affordable Care Act

Source: Leavitt Partners Center for Accountable Care Intelligence

Serving over 18 million people

Accountable Care Organization (ACO)

DEFINITION

An ACO is an organization of health care providers that

agrees to be accountable for the overall care and cost of

care for assigned beneficiaries

Changing Healthcare Context

Fee for Service

Pay for Performance

Shared Savings

Shared RiskGlobal

Payment

Focus on IndividualsIndividuals and

PopulationsIndividuals, Populations

and Communities

Care Care and Cost The Triple Aim

Do to Do for Do WITH

An All Too Familiar ScenarioIt’s scary

when I

can’t

breathe.

Sometimes I’m

just too tired to

go to the

doctor.

I miss my

family.

An All Too Familiar Reaction

I know what

she needs,

but not how

to help her.

If only

someone

could

check on

her.

I don’t have the

time or the

resources.

Foundational Setup for Population

Management

1. Choose a relevant Population for improved health, care and lowered cost.

2. Identify and develop the Leadership and Governance for your effort.

3. Articulate a Purpose that will hold your stakeholders together.

Whittington, John, Kevin Nolan, Ninon Lewis, and Trissa Torres. "Pursuing the Triple Aim:

The First 7 Years." Milbank Quarterly 93.2 (2015): 263-300.

Delivery of Services at

Scale

Community, Family and Individual Resources

Managing Services for a Population

FeedbackLoops

Needs Assessment for

SegmentService Design

CoordinationGoals

Integrator

Population Segmentation

Population Outcomes

FeedbackLoops

Activities of a Population Management

Learning System

What Might Care Redesign Look Like?

EMS implements shared protocol to treat instead of

transport if appropriate

Care manager checks on her

regularly

Her son gets her a tablet and sets up Facetime

Physician’s office staff ask church members

to visit

How Might That Feel?32

My team

has

come

together.

I am thrilled

we are

helping Mrs.

Jones.

Her family, church,

and community

have all come

together to help

too.

Dr. Patel’s team

helps me.

I’m not

afraid.

I don’t feel

lonely

anymore.

Where to Start?Step 1: Identify Strategic Populations for Triple Aim Work

Foundational Setup for Population

Management

1. Choose a relevant Population for improved

health, care and lowered cost.

2. Identify and develop the Leadership and

Governance for your effort.

3. Articulate a Purpose that will hold your

stakeholders together.

Start with understanding the type of

population you will focus on:

Enrolled versus Community

Triple Aim Participant Populations

• Enrolled Populations: Enrolled populations are typically, a group of individuals receiving care within a health system, FQHC, or whose care is financed through a specific health insurance plan or entity

• Community-Wide Populations: Working in a geographic area to accomplish the Triple Aim for the community

Triple Aim

Results

Enrolled Populations

Community-Wide

Populations

Which Population Are You Choosing?

• Enrolled Populations

• Community-Wide Populations

• Please type in the chat window your population

of focus and how many individuals are in that

population

Enrolled Populations

“Enrolled populations are typically a group of individuals

who are receiving care within a health system or whose

care is financed through a specific health insurance plan or

entity.”

- Pursuing the Triple Aim: The First 7 Years ,Whittington, et al, The Milbank

Quarterly, Vol. 93, No. 2, 2015 (p. 267)

Considerations: Enrolled Populations

Is the leadership (CEO, executive team) of the

organization on board with the importance of

managing and supporting the Triple Aim or do

you have to make the case for this?

For health systems or other health

organizations: do you think that population

management is important for your future?

Community Populations

“Regional/community populations are population segments

defined geographically. Segments of a community

population are often unified by common needs or issues,

such as low-birth-weight babies or older adults with

complex needs. These individuals may receive care from a

variety of systems or may not be connected to care at all,

and they may or may not be insured.”

- Pursuing the Triple Aim: The First 7 Years ,Whittington, et al, The Milbank

Quarterly, Vol. 93, No. 2, 2015 (p. 267-268)

Considerations: Community Groups

Do you have a clear purpose on why this work is

important for the community?

Do you have the leadership in the community to support

this work?

What are the compelling reasons in your community to

form a coalition to work on the Triple Aim?

Who might serve in the convener role?

What health impacts are important in your community?

What stakeholders might benefit from cost savings from

healthcare?

Population and Sustainability

For the chosen Triple Aim population do you

have a sustainable funding stream/business

model to support your work?

Create a Purpose Statement

Purpose Statement: Why Devote Time, Resources, Money?

Your organization’s strategic purpose or return on investment (ROI) for focusing time and resources

on a Triple Aim Population.

Why are you pursing the Triple Aim?

Create a Purpose Statement

Articulates the specific and strategic WHY the work is

important

Message a compelling reason to focus resources on the

work-head and heart

Creates shared vision that helps to hold stakeholders

together through the challenges

Orients the improvement team/s work towards focused

impact

Key Points

Statements should be clear, compelling, and include what, why, and when

If this work is strategic this statement should outline why it is strategic for the organization

All Triple Aim activities should be connected to the purpose

Once the Purpose Statement is formed, it should be communicated to all leaders in the organization/coalition, such that all can clearly articulate it.

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Purpose Statement: Pueblo Triple Aim

Coalition (PTAC)

“Ever-rising healthcare spending weakens Pueblo’s local

economy, threatens jobs, and has failed to deliver improved

health of Pueblo County citizens. This combination of

increased costs and poor results threatens Pueblo’s future

by diverting resources from investment in education and

growth. The Pueblo Triple Aim Coalition (PTAC) formed to

respond to these issues. PTAC’s goals are to improve

health, reduce the per capita cost of care and improve the

experience of care in Pueblo County, otherwise known as

the ‘Triple Aim.’”

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Example Purpose Statement

“ABC Health Network, a clinically integrated network (CIN), is a

collaboration between local providers and ABC that creates

value for our community through integrated and efficient health

care. The Network is dedicated to creating exceptional patient

experiences, optimizing the health of community members,

improving quality outcomes and lowering the cost of care. We

recognize that developing a sustainable model of health care

delivery requires change. The Network is leading this change by

establishing a unique care delivery model that aligns provider

activities across the continuum of care and aligns incentives with

payors and patients to improve the health of the community.”

Example Purpose Statement

“We seek to improve access to / utilization of primary care

and behavioral healthcare services to vulnerable

children. We will strive to positively impact children’s health

by strengthening integrated models of care for our city’s

Public School students within school-based health centers

and at behavioral health clinics serving city Public School

students. We hope to be able to measure expenditures with

the goal of reducing the per capita cost of care.”

Chat in or Raise Your Hand

What are your organizations’ or

communities’ strategic driving needs to

work on the Triple Aim?

What is your business case to do this

work?

Where To Start?Step 2: Form a Triple Aim Team

Activities of a Population Management

Learning System54

Triple Aim Portfolio Team

Executive Sponsor

Portfolio Manager (100% FTE)

Measurement Lead

Content Expertise

Member with strong Quality Improvement Expertise

Other stakeholders-other leadership and clinical stakeholders in the organization

Community Partners

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Triple Aim Portfolio Team-Example56

Triple Aim Role Organizational Position

Executive Sponsor Executive Director, Population & Public Health / Addiction &

Mental Health

Portfolio Manager (100% FTE) Director, Clinical Quality Improvement

Measurement Leads Director, North Zone Analytics &

Executive Director, Addiction & Mental Health, Primary &

Community Care

Content Expertise Director, Addiction & Mental Health

Clinical Project Lead

Member with strong Quality

Improvement Expertise

(Acting) Director, Integrated Planning

Other stakeholders-other

leadership and clinical

stakeholders in the

organization

(as needed)

Information Technology Finance Clinical Informatics Communications

Community Partners None for this team

Pueblo Triple Aim Structure

High Level Policy and Governing Board: Pueblo Triple Aim

Corporation

– High Level Community Support

Advisory Council: Pueblo Triple Aim Steering Committee

– “Boots on the Ground”

Ad-Hoc Committees: Portfolio Specific

– Deal with shorter-term, single issue needs

Action Step: Purpose

Meet as a group and articulate areas of strategic importance for your organization to pursue the Triple Aim.

Write a purpose statement for your organization’s work in the Triple Aim.

Compose your core Triple Aim team if you have not already

Send your Purpose Statement and team composition to Julie Landsman at jlandsman@ihi.org

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Communication and Materials

A recording of this and all calls will be emailed to

you

Materials will be shared the day before each

session

Communicate to faculty and other participants

through our listserv: kickstartfeb2016@ls.ihi.org

Pose questions, share resources, discuss barriers or

successes

– Email jlandsman@ihi.org if you or your colleague would like to

be added

– Primary enroller for your organization was automatically added

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Next Session

Session 2: Managing Populations

Wednesday March 9th, 2016

11:00 AM - 12:30 PM ET

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Poll62