Integrated Care: Triple Aim & CHF.pdf

The U.S. health care system needs to simultaneously pursue three aims to improve: enhancing care experience, improving population health, and reducing per capita costs. This requires enrolling an identified population, committing to universal care, and having an 'integrator' organization responsible for all three aims. The integrator's role includes partnership with individuals, care redesign, population health management, financial management, and system integration. Current care, exemplified by congestive heart failure (CHF) management, lacks integration, leading to poor outcomes and high costs. Recent U.S. health system performance is subpar despite high expenditures. Most improvement efforts focus on single-site care, neglecting care continuum defects. The 'Triple Aim' addresses this by targeting individual care, population health, and cost reduction, which are interdependent and subject to policy constraints. Pursuing the Triple Aim is not currently in the immediate self-interest of most U.S. health care organizations due to market forces and payment incentives. Overcoming this 'tragedy of the commons' is crucial for achieving universal coverage and reducing costs.