Can Healthcare Organizations Lead in Population Health Improvement?

By David A. Kindig, MD, PhD

Two weeks ago I floated the concept of a “Super-Integrator” to play an effective but neutral coordinating role in population health improvement. I believe there are multiple, equally effective forms such integrators could take. Although we don’t yet have complete exemplars for this concept, we do have examples of organizations moving in the right direction. This week, we’re showcasing one of them.

The Institute for Health Improvement is a highly regarded healthcare improvement organization that has moved beyond solely health care through its Triple Aim strategic initiative. The initiative illustrates how healthcare organizations are reaching beyond their traditional roles to address a broad range of health factors.

John Whittington, MD is IHI’s Lead Faculty for the Triple Aim. We met through my response to IHI’s Health Affairs article on the Triple Aim.  I recently invited John to describe the IHI current movement into a Triple Aim regional population strategy.

DAK: John, would you first briefly describe the IHI?

JW:  The Institute for Healthcare Improvement was founded in 1991 by Don Berwick and a small group of colleagues who were committed to redesigning health care into a system no longer plagued by errors, waste, delay, and unsustainable social and economic costs. Today IHI is a small, not-for-profit organization based in Cambridge, Massachusetts, helping to lead the improvement of health care – making care better, safer, and more affordable – throughout the world.

DAK: What is the Triple Aim, and how did it evolve from IHI traditional work?

JW: In 2005, IHI had a vision to work on three simultaneous aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. In 2006, research and development began on this Triple Aim. In 2007, 13 organizations joined in a partnership with IHI to work together. Today, over 70 organizations from around the world work with the IHI on the Triple Aim. Each organization that partners with IHI acts as an integrator of care for a defined population, working on five change principles: (1) encouraging prevention and health promotion, (2) improving and broadening primary care, (3) helping individuals co-create care, (4) improving front line care that builds social capital with other health producing organizations in a community, and (5) working directly on cost control.

DAK:  Can you also tell us about the regional strategy that is evolving from Triple Aim work?

JW: Some of the 40 organizations that work on the Triple Aim in the US are focused on small homogenous populations, such as their own employees. The 30 international sites focus on total populations in geographic regions such as a primary care trust in England. By observing the international sites and some US sites, much has been learned about regional work. IHI sees the need to push the work of the Triple Aim to entire populations in geographic regions in the US. Our regional approach is based on the work of Tom Nolan (a key architect of the Triple Aim), and shaped by the belief that regions (1) are self-sufficient and contain all the necessary components for constructing a health system, (2) tend to have common values, (3) allow solutions to be driven by local context and expertise, (4) have existing platforms for dialogue (or opportunities for creating them), and (5) are characterized by a full range of health factors or determinants, including but not limited to healthcare.

DAK:  Many readers of the blog will be aware that IHI’s founder Don Berwick has recently assumed a new post as Administrator of the federal CMS (link). Who has taken over at IHI, and what impact dies this have on the Triple Aim or regional plans?

JW: IHI is honored that President Obama has chosen Don to lead CMS, and that he’ll have the opportunity to advance the cause of health care improvement especially at this time. IHI’s Board immediately named Maureen Bisognano, IHI’s former Chief Operating Officer, as IHI’s next President and CEO.  Maureen has been Don’s chief partner in IHI’s management and vision since she joined IHI in 1995, so IHI’s not missing a beat in carrying the work forward to meet the challenges ahead. Our Triple Aim work is more important than ever.

David A. Kindig, MD, PhD, is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.

Comments

[Helene Nelson]

Thanks for opening this conversational door. I like the triple aim concept and would like Wisconsin to explore how we can pursue it more fully here. Still, I also wonder about the answer to the provocative question that you used as the title to this essay, and a broader question: WHO will lead for population health improvement (anyone)? Will you follow-up on this conversation in the blog?