The  Triple  Aim  is  vital  to  our  collective  health  DAVID  NASH,  MD,  MBA  |  POLICY  |  SEPTEMBER  15,  2013    In  2008,  a  couple  of  years  before  the  Affordable  Care  Act  became  the  law  of  the  land,  Donald  M.  Berwick,  MD,  and  his  colleagues  at  the  Institute  for  Healthcare  Improvement  (IHI)  introduced  the  Triple  Aim  concept  and  set  to  work  on  ways  to  (1)  improve  population  health,  (2)  increase  patient  satisfaction  and  (3)  reduce  per  capita  healthcare  costs.    In  pursuit  of  these  goals,  IHI  encouraged  the  exploration  of  a  variety  of  population  health  interventions  —  primary  care  promotion,  enhanced  communications  between  physicians  and  patients  through  e-­‐mail  correspondence,  and  targeted  education  initiatives  to  promote  self-­‐management  of  chronic  conditions  to  name  just  a  few.  But,  until  recently,  the  term  “population  health”  prompted  questions  even  among  my  colleagues  at  Thomas  Jefferson  University.    Since  “Obamacare”  took  effect  in  2010,  fans  and  foes  alike  have  been  struck  by  how  fast  we  are  moving  toward  the  fulfillment  of  the  Triple  Aim  and  the  true  practice  of  population-­‐based  healthcare.    This  movement  is  prompted,  in  no  small  measure,  by  the  law’s  call  for  broader  health  insurance  coverage  (i.e.,  health  insurance  exchanges),  greater  connectivity  and  population-­‐based  analytics,  improved  care  coordination,  and  increased  patient  engagement.    There  is  ample  evidence  that  the  population  health  movement  has  begun  to  spread  beyond  the  usual  cited  organizations,  incluidng  the  Kaiser  Foundation,  the  Mayo  Clinic,  and  Geisinger  Health  System.    Electronic  health  record  (EHR)  companies,  for  instance,  are  inventing  new  strategies  to  facilitate  the  move  to  population  health  management  by  integrating  patient  data  from  disparate  health  information  systems,  organizing  it  for  easy  clinical  access,  and  delivering  it  to  clinicians  at  the  point  of  care.  Example:  Allscripts  has  begun  to  leverage  aggregated  EHR  data,  analytics,  and  patient  portal  technology  to  develop  tools  for  clinical  decision  making  and  patient  self-­‐management.    The  company  sponsors  a  Population  Health  Forum  where  caregivers  from  around  the  country  share  examples  of  how  population  health  management  is  enabling  them  to  improve  upon  their  clinical  protocols  while  dramatically  reducing  costs.  Retail  pharmacy  chains  are  taking  more  active  roles  in  population  health  management  by  applying  clinical  analytics  and  predictive  modeling  to  their  rich  pharmaceutical  data.    Example:  Recently,  Walgreens  developed  a  stratified  approach  to  identify  subpopulations  of  patients  who  are  at  risk  for  “triple  fail  events”  —  (1)  suboptimal  

health  outcomes  that  are  (2)  overly  expensive  and  (3)  result  in  patient  dissatisfaction  —  who  could  benefit  from  preventive  measures.    In  this  way,  the  pharmacy  can  better  determine  which  subsets  of  patients  are  at  high  risk  –  for  events  such  as  unplanned  hospital  readmissions  within  30  days,  untimely  nursing  home  admission,  or  over-­‐medicalization  at  the  end  of  life  –  and  direct  information  and  other  appropriate  resources  to  patients,  their  physicians,  and  their  caregivers  preventively.    Health  care  consulting  companies  are  entering  the  population  health  arena  in  new  and  potentially  beneficial  ways.    Example:  Aegis  Health  Group  recently  launched  a  password-­‐protected  online  population  health  portal  designed  to  help  employees  identify  and  address  their  health  risks  proactively,  and  to  provide  employers  with  aggregate  data  and  analytics  for  making  decisions  regarding  employee  wellness  programs  and  incentives  for  completing  programs.    I  am  energized  by  the  growing  number  of  organizations  that  recognize  the  Triple  Aim  as  vital  to  our  collective  health  —  and  I  look  forward  to  seeing  fewer  puzzled  expressions  when  I  say  that  I  am  the  dean  of  a  school  of  population  health.    David  B.  Nash  is  founding  dean,  Jefferson  School  of  Population  Health,  Thomas  Jefferson  University