Ron Yee, MD, MBA, FAAFPSenior VP, Clinical Affairs Division

Chief Medical Officer

“Triple Aim in Healthcare: Strategic Role of CHCs”

Agenda

• Institute for Healthcare Improvement (IHI)

Triple Aim Background

• Examples from the United States

1. Improving the patient experience of care

2. Improving the health of populations

3. Reducing the per capita cost of care

4. Bringing it all together

• How Do We Do This in Canada?

IHI Triple Aim

• Framework to describe an approach to optimize health

system performance

• All three elements must be pursued simultaneously

• Why? The US health care system is the most costly in the

world with 17% of GDP spending, going to 20+% by 2020

• IHI move from “What’s the matter?” medicine to

“What matters to you?” medicine

• 90-day harvest cycles of innovation since 2006

• 5,000 hour example; improving patient outcomes

• What matters to patients, assess assets, create new

systems to provide care

IHI Triple Aim

http://www.ihi.org/Engage/Initiatives/TripleAim/Documents/ConceptDesign.pdf

Improving Patient Experience of Care

Patient Engagement Toolkit

• Patient Advisory Councils

• How to create, training

• Patient Experience Survey

• Patient portals

• CAHPS, aligned with NCQA

19 key requirements

• Social Determinants of Health

• Barrier & asset mapping

• 20 Domains

• Clinical metrics c/w HP2020

• HTN, DM, Cx CA, Tobacco,

BMIhttp://cchn.org

• Comprehensive approach to SDH

• Medical care and social services integration

• ESL, vocational training, legal services, housing, community gardens, microcredit loans for women entrepreneurs, SA recovery

• Close community ties

• 28 culturally diverse populations served

Improving Population Health

La Maestra Circle of Care

http://www.lamaestra.org/circle-of-care/default.html

Decreasing Per Capita Cost/Value

http://www.elrio.org

• Founded in 1970, 6 primary sites

• “Best Practice” Pharmacy-based DM

Management program (6 nationally),

Innovative Research Award, NACHC

• Worked with payer who provided ER

and IP daily discharge data

• Risk stratified patient reports & action

• Over 2 years

• Addressed high risk patients

• Transitions of care, 7D f/u

• Reduced non-emergent ER-41%

• Reduced avoidable admits-25%

• Increased membership by 52%

• Split savings $4M

Bringing it All Together

• Serving Southern California for

over 45 years

• Birth through elder care, 43 sites,

930,000 visits a year

• Primary medical, dental, senior

long-term care, SA, HIV/AIDS,

BH, Chronic Care, Pharmacy, etc.

• Owns own IPA/MC network

• Highest 2014 Quality Award

winner in California; $259,132 of

incentives awarded

• PCMH, Pt. Safety, HEDIS metrics,

Evidence-based practices

• Blended Triple Aim objectiveshttp://www.altamed.org

How Do We Do This In Canada?

• Get started!

• Optimize existing data – know and use your data

• Engage and listen to your patients – they know best!

• Be creative and innovate more efficient and cost

effective approaches to patient care

• Look for local partners and mutual benefit

• Document small wins & successes and celebrate

• Do friendly comparisons – with self and others

• Share successful models and continuously improve

• Fulfill the Triple Aim!

Ron Yee, MD, MBA, FAAFPSenior VP, Clinical Affairs Division

Chief Medical Officer

“Triple Aim in Healthcare: Strategic Role of CHCs”