Is Healthcare Technology Caught In The Crosshairs of Triple Aim? Margalit Gur-Arie explores the challenging role of healthcare technology in Triple Aim.
“Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs” [ihi.org]
If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving wizardry or wishful thinking or worse, propaganda for the masses, particularly the last part. It’s like attempting to build a better driving machine, with better fuel efficiency at lower cost. Or maybe it’s like trying to make a chocolate cake that is most scrumptious, quicker to prepare and has very few calories. Yeah, right…. You can have one of the three, and maybe two, but certainly not all three. Not that there is anything wrong with trying…. And when it comes to health care it is actually imperative that we try, and failing will have dire consequences for all but the very few who are always shielded from consequences.
The Institute for Health Improvement (IHI) who introduced the Triple Aim philosophy, now adopted by the government, is also proposing a methodology for achieving this, larger than the moon landing, challenge. The IHI will be having a seminar this spring, where those engaged in achieving the Triple Aim will presumably share success stories and strategies with those interested in doing the same. IHI believes this learning event is “ideal” for folks working for insurers, employers, government, integrated health systems and other businesses and organizations. Individuals, populations and their doctors don’t seem to be part of the IHI target market. It seems that IHI believes that the Triple Aim of research institutions should be achieved by corporations, for the people of this country and the world in general. It also seems that this particular view is shared by our government, who is feverishly pushing for the creation of corporate health care entities (a.k.a. ACO), and, patient-centered rhetoric notwithstanding, is largely ignoring doctors and their patients, who are assigned to care corporations sometimes unbeknownst to them.
In addition to a slew of financial incentives/disincentives, Health Information Technology (HIT) is one of the most powerful levers applied to the system in order to change its fabric from a multitude of small and varied health care establishments to a unified landscape of large standardized health services entities, which as IHI, and obviously all other “decision makers”, “thought leaders”, etc., believe are best suited to build a system for achieving the Triple Aim in an orderly and measurable fashion. A health care system as opposed to a sick care system; a system where populations get all their shots and screenings for every imaginable disease, carefully tabulated and monitored to show progress, and a system where care for the sick is optimized for “value” to the IHI “ideal” stakeholders; a system that requires massive computation power to constantly drive costs down by feeding millions of digital histories of people to complex algorithms; a sophisticated supply chain system that replaces continuity of care with electronic coordination of services, and generally keeps the proverbial trains running on time; a system powered by billions of dollars of computers, software and IT guys.
And here is where the “official” strategy gets really weird, wasteful, and luckily for all of us individuals, populations, and our doctors, it also contains the seeds of its own eventual demise. How so? Big business will always be saddled with expenditures on big technology, which is useless for small business, but technology has its own way of growing and advancing, independent of political whims, and independent of governmental master planners. Technology today is on a path to ever shrinking size (and price) and ever growing power, and as such it has morphed itself into a tool that truly empowers individuals and small business because those much maligned programmers, who don’t know anything about health care, are expert at building cool things for people and are some of the most nonconformist and visionary out-of-the-box inventors around. And they are now coming to health care seeking fame and fortune. But we have to give them time and we have to do our part in this dreadful game of world domination.
If you are a primary care physician in private practice, here are some things to keep in mind:
If you are a patient or think that someday you may need to be a patient, consider this:
When you find yourself in a strange room, partially covered by a large paper towel, and otherwise completely naked, contemplating the upcoming prodding of your most private body parts by shiny instruments and strange hands, what do you want to know most about the person about to enter the room? Would you feel better knowing that the stranger turning the knob on that door has an iPhone compatible website for you to peruse from the comfort of your cubicle at work? Would you feel safer knowing that he or she has financial responsibilities and commitments to a faceless corporate office for which your naked body is just a line item on the balance sheet, perhaps a socially responsible balance sheet, but a balance sheet nevertheless? If it’s your small child under that paper towel, would you be comforted knowing that this person’s prime directive is to minimize your child’s “per capita” cost (not price) of care? And when you’re done making imaginary deals with your God or the devil, would you experience great relief knowing that the doctor walking into the room now is not really “your” doctor, but the shepherd of “populations” and the averter of deficits and fiscal cliffs?
Don’t answer these questions now, or right after you finish your morning run. Answer them when you are actually sitting in that room because Google said that the pesky little thing you found last week is most likely nothing serious, or of mild concern, or a cancer that will kill you in a year or two. Depending on your answers, you may want to seek out an independent physician for your next appointment, because the opposite of “independent” may be hazardous to your health.
The IHI concludes the promotional blurb for its Triple Aim seminar by proudly stating that these seminars were attended by “senior leaders, vice presidents or directors” in the past, and although individuals are welcome, ”experience has shown that Triple Aim implementation is dependent on the collaborative effort of leaders and strong program involvement”, so according to the IHI “leaders”, if you’re not a corporation or powerful enough organization, don’t waste your time (and $1,975) and don’t worry your little head about it, because individual people cannot make a difference in health care.
It’s probably high time that we took some triplicate aims of our own, don’t you think?
Featured image credit: http://blogs.cisco.com/tag/mgn/