A Care Model To Achieve The Triple Aim

by Alicia Caramenico

June 3, 2016

What does it take to achieve the triple aim of more affordability, a healthier population, and a better patient experience? It’s putting the focus on value rather than on cost alone.

HealthPartners does that with its Total Cost of Care (TCOC), a population-based model that accounts for all of the care provided to a patient, how much the care cost, where they received the care, and which types of providers delivered it. The TCOC model addresses the misaligned incentives and underlying problems of fee-for-service medicine, including payments based on the amount of health care services provided, inconvenience for patients, and little incentive for care management activities that promote quality, cost-effective care.

HealthPartners developed the TCOC model in partnership with Entira Family Clinics, a medical group practice that has more than 25 years of managed care experience. Through the TCOC model, HealthPartners and Entira focus care management efforts on improving patient transitions between care settings, such as to and from the hospital, and proactively reaching out to patients about screenings for depression, alcohol, and falls.

The TCOC model has enabled physicians to spend more time with patients that have complex health needs, as well as improved access to care through the use of e-visits and video visits. Also, physician assistants, registered nurses, and case manager/social workers play a big role in the TCOC model. With a broader care team, increased patient “touches” promote enhanced communication, adherence to treatment plans, and good outcomes.

Using this model, HealthPartners has outperformed Minnesota, regional, and national risk-adjusted cost of care benchmarks for three consecutive years. Building on that success, continued collaboration, good analytics, and data sharing will further the evolution away from FFS towards delivery models like the TCOC that make health care more affordable without compromising care quality or patient experience.

Note: This content was based on presentations at the AHIP Payment Reform Summit in October 2015.