Triple Aim and Health Care Delivery Models

Triple Aim and Health Care Delivery Models

 

Triple Aim and Health Care Delivery Models

Delivering high-quality health care services depends on the coordination and integration of the health care delivery systems. The American healthcare system consists of an array of stakeholders, including regulators, clinicians, insurance plans, hospitals, healthcare facilities, independent practitioners, and consumers. Likewise, the issues pursued in health care are diverse such as access to care, health equity, costs, management of chronic conditions, vulnerable populations, preventive services, and mental health. All these require an integrated health system to unify the responsibilities of various entities and promote efficient performance. The public health system uses several models of health care service delivery to promote the integration and coordination of multiple services. Equally, the public health system employs strategies to support constant improvement in health services within the larger framework of the public health system. One such strategy is the Triple Aim, which denotes the simultaneous pursuit of three goals: high-quality care, improving population health, and enhancing the cost-effectiveness of health care services. The purpose of this paper is to analyze the Triple Aim strategy as it relates to population health and health care delivery models.

Triple Aim and Population Health Management and Delivery Models

The Triple Aim introduced by the Institute for Healthcare Improvement (IHI)in 2008 is an umbrella term for three elements that aim to collectively improve health service delivery, promote universal access, and enhance the health of populations. The three items are the experience of care, per capita cost, and population health(Shahzad et al., 2019). The Triple Aim strategy aligns with the outcomes-based approach to health care, which emphasizes overall healthcare improvement rather than focusing on a few specific areas,such as reducing medication errors. Outcomes-based is a population health-focused approach that enhances the delivery of health services that leads to positive outcomes for populations instead of merely treating those who are not well. According to Shahzad et al. (2019), population health is a move from the traditional individual acute care to the health and wellness of the entire population. A population is a group of people with similar health or social needs.

The Triple Aim is the foundation of population health management. According to the Triple Aim strategy, the guideline for identifying the relevant population is choosing a population within which all the three aims are applicable. For example, a healthcare organization can choose to enhance positive health outcomes for people with complex needs that lead them to use health services frequently, leading to high cost, utilization of healthcare resources, and duplication of services(Shah & Aurelio, 2021). Proper health management strategies for such a population will see the members visiting the hospital less, leading to reduced utilization of health services, reduced cost, and better patient experience because of favorable health outcomes.

To create value for populations, the Triple Aim recommends a structure that achieves an integration of various health care elements and stakeholders to work collaboratively to deliver efficient and effective care. Thus, integration of services is critical to achieving the aims of Triple Aim. Consequently, the current health care delivery models provide integrated care that achieves the purposes of quality services, population health improvement, and cost-effectiveness (Shah & Aurelio, 2021). For example, the Accountable Care Organizations (ACO) model is one such model that promotes the integration of services to enhance efficient resource utilization. ACO improves care coordination and integration through a collaborative process that involves leveraging resources and information to make service delivery efficient and effective. ACOs are also driven by financial incentives achieved through care coordination (ANA, 2020). The ACO model of service delivery relates to Triple Aim because it enhances quality of care leading to patient experience, focuses on managing people with chronic conditions and promoting preventive care, and lowers the cost of service provision through resource sharing.

Trends in Healthcare Delivery Models

The current healthcare delivery models are the pay-for-performance (P4P) approaches. The p4p model denotes a system that rewards the healthcare service providers based on their performance and measurement reports. The P4P looks at the quality and efficiency indicators and rewards hospitals with good performance in various areas, including quality, patient satisfaction, infection control, etc. Similarly, a hospital that records poor performance becomes penalized financially, and the funds are channeled to ease costs for payers. The Centers for Medicare and Medicaid Services (CMS), which controls over 40% of healthcare funding,has developed several P4P systems, including the Hospital Readmissions Reduction Program (HRRP), Hospital-Acquired Condition (HAC) Reduction Program, and Hospital Value-Based Purchasing Program (VBP)(ANA, 2020).Similarly, commercial insurers are also embracing the P4P model in healthcare. According to a report, over 60% of private reimbursements are based on a P4P model. Examples of such models in healthcare include Value-Based Compensation Initiative (VBCI) and Pay-for-Performance Deals (Powers et al., 2021).

Another delivery model currently popular in health care is the ACO. As mentioned earlier, ACOs consist ofhealthcare organizations, private entities, and physicians that come together to deliver well-coordinated care to Medicare patients. The rationale behind ACO is to manage a population of people with chronic illnesses by enhancing communication and collaboration amongst the individuals and entities involved in patient care, helping to streamline services and eliminate duplication. The efficiency achieved with ACO organizations greatly improvesthe quality of care, lowers costs spent by people with chronic diseases, and improvesthe population’s overall experience, leading to a high quality of life. ACOs focus on disease prevention and better delivery in primary care, reducing unnecessary admissions and costs associated with preventable readmissions and emergency room visits. The current trends in ACOs involve the participation of advanced practice nurses as part of the team driving the management of chronic illnesses and providing patient education to promote population health outcomes.

Similarly, the Preferred Provider Organization (PPO) is another healthcare delivery system. The model allows patients to access various healthcare professionals within a network, including specialists and general physicians. The model does not require users to have a primary physician, as they have the freedom to seek heath services anywhere within the network without a referral. On the other hand, Health Maintenance Organization is another service delivery model that requires users to select a primary. The system requires users to choose a primary care provider who makes referrals when the patient needs specialized services. Furthermore, the Point of Service delivery model combines many features. For example, the patient chooses a primary care provider and can access health services outside the provider’s recommended network. Lastly, emerging healthcare models increasingly recognize the role of nurses as care integrators rather than merely caregivers. These models give nurses the autonomy to create innovative solutions to address challenges in the clinical environment.

Quality and Safety

Quality and safety are impacting delivery models in healthcare because of the introduction of value-based systems. The value-based payment systems rely on incentives to encourage quality improvement and cost control. The focus of value-based systems is to support continuous improvement in healthcare. As a result, healthcare service providers adapt to the needs of value-based care by creating models that promote integration, coordination, and collaboration to enhance efficiency, quality, and patient safety (Francavilla, 2019). For example, healthcare facilities are adopting nursing care delivery models that enhance quality and safety outcomes for patients. A survey of nursing delivery models reveals that incidences of adverse events reduce when nurses work as a team (Havaei et al., 2019). This is the rationale behind the much-favored interprofessional collaboration in healthcare. The approach brings together various healthcare professionals working in a particular patient’s case to share information and insights to better care and positive patient outcomes. Additionally, the quality measures such as patient experience, hospital-acquired infection rates, and length of hospital stay, among others, have become critical in today’s healthcare environment as part of improving safety and quality. Therefore, the service delivery models focus on supporting the culture of improvement to sustain quality and safety.

Conclusion

Healthcare delivery models have evolved from a fee-for-service approach to a value-based system that prioritizes patient safety and quality. The Triple Aim strategy is one of the factors attributed to the transformation. The strategy calls for cost-effectiveness, patient experience, and population health management, which requires a coordinated model to enhance the integration of the public health systems. The value-based delivery models such as pay-for-performance and ACOs are driving service delivery, focusing on leveraging resources, communication, and information technology to enhance quality outcomes and promote the wellbeing of populations. The population-focused approach ensures that evidence-based practices support the management of chronic conditions and preventive measures.

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References

ANA. (2020). New Care Delivery Models in Health System Reform: Opportunities for Nurses & their Patients. ANA ISSUE BRIEF, https://www.nursingworld.org/~4af0e8/globalassets/docs/ana/ethics/new-delivery-models—final—haney—6-9-10-1532.pdf.

Francavilla, C. (2019). Understanding the Impact of Care Delivery Models in Value-Based Payment. Medsurg Nursing, 5(28), 331-338.

Havaei, F., MacPhee, M., & Dahinten, S. (2019). The effect of nursing care delivery models on quality and safety outcomes of care: A cross-sectional survey study of medical-surgical nurses. J Adv Nurs, 75(10), 2144-2155. https://doi.org/ 10.1111/jan.13997.

Powers, B. W., Shrank, W., & Navathe, A. (2021). Private Equity and Health Care Delivery: Value-Based Payment as a Guardrail? JAMA, 326(10), 907-908. https://doi.org/10.1001/jama.2021.13197.

Shah, A., & Aurelio, M. (2021). Quality improvement in practice—part three: achieving the triple aim through the systematic application of quality improvement. British Journal of Healthcare Management, 27(10), https://doi.org/10.12968/bjhc.2021.0041.

Shahzad, M., Upshur, R., & Donnelly, P. (2019). A population-based approach to integrated healthcare delivery: a scoping review of clinical care and public health collaboration. BMC Public Health , 19, 708. https://doi.org/10.1186/s12889-019-7002-z.

Write a 1,250-1,500-word essay about delivery models in health care. Include the following in your essay:

Address the triple aim as it relates to population health management and delivery models.
Discuss current trends in health care delivery models.
Describe how quality and safety impact delivery models in health care.
Include at least three peer-reviewed/academic references in your essay, including the HealthyPeople website.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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Delivery Models Essay – Rubric

Collapse All Delivery Models Essay – RubricCollapse All

Triple Aim

19.2 points

Criteria Description

Triple Aim

5. Target

19.2 points

The essay thoroughly and skillfully identifies the triple aim as it relates to population health management and delivery models.

4. Acceptable

17.66 points

The essay thoroughly identifies the triple aim as it relates to population health management and delivery models.

3. Approaching

16.9 points

The essay identifies the triple aim as it relates to population health management and delivery models.

2. Insufficient

15.36 points

The essay vaguely identifies the triple aim as it relates to population health management and delivery models.

1. Unsatisfactory

0 points

The essay does not sufficiently identify the triple aim as it relates to population health management and delivery models.

Current Trends in Health Care Delivery Models

18.4 points

Criteria Description

Current Trends in Health Care Delivery Models

5. Target

18.4 points

The essay thoroughly and insightfully discusses current trends in health care delivery models.

4. Acceptable

16.93 points

The essay thoroughly discusses population current trends in health care delivery models.

3. Approaching

16.19 points

The essay discusses current trends in health care delivery models.

2. Insufficient

14.72 points

The essay does not clearly discuss current trends in health care delivery models.

1. Unsatisfactory

0 points

The essay does not adequately discuss current trends in health care delivery models.

Quality and Safety

18.4 points

Criteria Description

Quality and Safety

5. Target

18.4 points

The essay expertly describes how quality and safety impact delivery models in health care.

4. Acceptable

16.93 points

The essay soundly describes how quality and safety impact delivery models in health care.

3. Approaching

16.19 points

The essay adequately describes how quality and safety impact delivery models in health care.

2. Insufficient

14.72 points

The essay vaguely describes how quality and safety impact delivery models in health care.

1. Unsatisfactory

0 points

The essay does not adequately describe how quality and safety impact delivery models in health care.

Thesis, Position, or Purpose

5.6 points

Criteria Description

Communicates reason for writing and demonstrates awareness of audience.

5. Target

5.6 points

The thesis, position, or purpose is persuasively developed throughout and skillfully directed to a specific audience.

4. Acceptable

5.15 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

3. Approaching

4.93 points

The thesis, position, or purpose is adequately developed. An awareness of the appropriate audience is demonstrated.

2. Insufficient

4.48 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

1. Unsatisfactory

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

Development, Structure, and Conclusion

6.4 points

Criteria Description

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

5. Target

6.4 points

The thesis, position, or purpose is coherently and cohesively advanced throughout. The progression of ideas is coherent and unified. A convincing and unambiguous conclusion aligns to the development of the purpose.

4. Acceptable

5.89 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and plausible conclusion aligns to the development of the purpose.

3. Approaching

5.63 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

2. Insufficient

5.12 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

1. Unsatisfactory

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

Evidence

4 points

Criteria Description

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

5. Target

4 points

Comprehensive and compelling evidence is included. Multiple other perspectives are integrated effectively.

4. Acceptable

3.68 points

Specific and appropriate evidence is included. Other perspectives are integrated.

3. Approaching

3.52 points

Relevant evidence that includes other perspectives is used.

2. Insufficient

3.2 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

1. Unsatisfactory

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

Mechanics of Writing

4 points

Criteria Description

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

5. Target

4 points

No mechanical errors are present. Skilled control of language choice and sentence structure are used throughout.

4. Acceptable

3.68 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

3. Approaching

3.52 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

2. Insufficient

3.2 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

1. Unsatisfactory

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

Format/Documentation

4 points

Criteria Description

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc.,

5. Target

4 points

No errors in formatting or documentation are present. Selectivity in the use of direct quotations and synthesis of sources is demonstrated.

4. Acceptable

3.68 points

Appropriate format and documentation are used with only minor errors.

3. Approaching

3.52 points

Appropriate format and documentation are used, although there are some obvious errors.

2. Insufficient

3.2 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

1. Unsatisfactory

0 points

Appropriate format is not used. No documentation of sources is provided.

Total 80 points