Cost Cube Triple Aim[1]
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Cost Cube
Gerry Marr
Chief Operating Officer, NHS Tayside
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NHS Tayside Cost Profile 2006/07
Total Cost Cube
Cost Cube Share of
Total£000 £000 %
Hospital & Community Costs 469,308 267,503 57.0%
Prescribing 76,205 76,055 99.8%
GMS 43,726 43,633 99.8%
Other FHS 31,116 - 0%
Administration Costs 4,932 - 0%
Other Non Clinical Services 9,916 - 0%
Total 635,203 387,191 61.0%
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Hospital & Community£469.31m (73.9%)
Prescribing£76.21m (12.0%)
Other Family Health
£31.12m (4.9%)
Other Non-Clinical£9.92m (1.6%)
General Medical Services£43.73m (6.9%)
Administration£4.93m (0.8%)
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Inpats & Day Cases£191,713 (30.2%)
A&E£5,595 (0.9%)
Prescribing£76,055 (12.0%)
Psychiatric£27,293 (4.3%)
Outpatients£35,175 (5.5%)
Labs£4,263 (0.7%)Radiology
£3,464 (0.5%)
Unassigned£248,012 (39.0%)
General Medical Services
£43,633 (6.9%)
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Elective Inpatients£93,04424.0%
A&E£5,5951.4%
Prescribing£76,05519.6%
Psychiatric£27,293
7.0%
Outpatients (New)£35,175
9.1%
Labs£4,2631.1%
Radiology£3,4640.9%
Day Cases£17,099
4.4%
Non-Elective Inpatients£81,57021.1%
General Medical Services£43,63311.3%
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0
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800
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GP Practices
Cost per Head by GP Practice 2006/07 (incl. GMS)
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Cost per Head by CHP (incl. GMS)
£924.94 £942.10£1,033.32
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
Angus CHP Dundee CHP Perth & Kinross CHP
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Range of Variation from mean Cost per Head between GP Practices
GMS
Day Cases
Psychiatry SMR04
Prescribing
Laboratories
Radiology A&E
Elective Inpatients
Outpatients (New)
Non-elective Inpatients
-£200
-£100
£0
£100
£200
£300
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-£150
-£100
-£50
£0
£50
£100
£150
£200
£250
Range of Variation from mean Cost per Head between GP Practices
Elective Inpatients
Non Elective
Inpatients
Day Cases
Prescribing
Outpatients (New)
Psychiatry SMR04
A&ELaboratories
Radiology
GMS
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GMS vs non-GMS Expenditure by Practice Population
80
90
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110
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140
500 600 700 800 900 1000 1100 1200
Non-GMS Spend per Head
GM
S S
pe
nd
pe
r H
ea
d
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Costs vs Expected at Tayside Average (incl GMS)
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Expected Value
Ratio
+2σ
-2σ
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Cost vs Expected - Non Elective Inpatients (Anonymised)
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0 500000 1000000 1500000 2000000 2500000 3000000
Expected Value
Rat
io
+2σ
-2σ
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Cost vs Expected - Prescribing (Anonymised)
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Expected Value
Rat
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+2σ
-2σ
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The ‘Triple Aim’
Gerry Marr
Chief Operating Officer
NHS Tayside
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The “Triple Aim”
Health of the Population
Experienceof Care
Per CapitaCost
15
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Macro-Integrator
• It is not a new structure or organization
• It pulls together the resources to support a defined population
• It optimizes the Triple Aim for the sake of a defined population
• It works with and helps to improve micro-systems to support individuals
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Some System Components to Accomplish the Triple Aim
• Individuals and families
• Redesign of “primary care” services and structures
• Population health management
• Cost control platform
• System integration
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1. Individuals and Families
• Partnership between families and caregivers for learning and enabling.
• Memory of individuals anywhere they go
• Joint planning and customizing care on best feasible outcomes
• Patient-controlled personalized health record
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2. Redesign of “primary care” services and structures
• Team definition
• Modes of access to services
• Medication management
• Cooperation and coordination with other specialties and hospitals
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3. Population health management
• Useful segmentation of the population, for example by level of family support or by type of disease
• Use of predictive models to deploy resources to high risk individuals
• Services customized by segment• Convenient access to information about
health• Public health interventions
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4. Cost control platform
• Defining and measuring per capita cost
• Target for inflation
• Break incentives for supply driven care
• New technology introduction
• Focus on the individual as a cost reduction strategy
• Yearly initiatives to reduce waste and the associated cost with all providers involved