To reduce the per capita cost of healthcare, improve the patient experience and the health of populations, hospitals and healthcare systems are striving to achieve a current framework known as the Triple Aim. In order to become successful, a joint report recently released by the American Hospital Association (AHA) Committee on Research and Performance Improvement explains that hospital leaders must design and adopt new care delivery systems that can be facilitated by innovative payment models that center on individual and community needs. For example, many payment models have emerged since that adoption of the value-based payment system, and they’ve all derived from one of three fundamental approaches:

• • Service-based payment: based on fee-for-service and primarily intended for small hospitals
  • Bundled-based payment: aggregates different services and providers, such as hospitals, physicians and post-acute providers bundling cost for hip replacements
  • Population-based payment: seeks to aggregate total care and costs across the continuum, such as an ACO for a defined population

Redesigning the delivery of care will require hospitals to disrupt their conventional way of thinking and reimagine care from the patient’s perspective. Hospitals must approach the Triple Aim with the appropriate payment model and through the following seven principles for care delivery design outlined by the AHA.

1. Design with the Whole Person Centered

The system design must begin with the patient—putting their needs and ease of access to care before the needs and convenience of the system and its clinicians. To develop a strong care delivery system, clinicians need to understand patient and consumer behaviors and motivations related to their care. There are several core elements that characterize a patient-centered care delivery system, which include:

• • Education and shared knowledge: Clinicians must work to educate patients with a greater focus on keeping them healthy, informed and better engaged in their care.
  • Shared decision making: Clinicians must be culturally adept to their communities to partner with their patients and make collaborative decisions about care needs based on their goals and motivations.
  • Involving family and friends: Stronger support networks will increase the patient’s adherence to care regimens and improve outcomes.
  • Collaboration: Since multiple clinicians are involved in a patient’s care, effective communication between all parties leads to greater collaboration.  
  • Cultural sensitivity: Understanding and supporting different cultures and spiritual beliefs is critical.
  • Incentives: Design incentives that encourage individual responsibility and accountability for health behaviors and lifestyle.

2. Empower through Information, Technology and Transparency

For people to be fully accountable for their own health, they need to be empowered through information supported with technology and communicated transparently. Technology should be used to support quality and safety efforts in addition to removing patient barriers, overcoming delivery system design flaws, and making it easier for patients to achieve their goals.

While technology can encourage patients to take on the role of managing their own health and healthcare, it can also facilitate effective communication between them and their provider—driving engagement, reducing medical errors, providing real-time decision support, and enhancing other quality and safety measures.

3. Build Care Management and Coordination Systems

To maintain an effective care delivery system, healthcare organizations must develop efficient, well-coordinated care teams that will communicate and collaborate effectively to minimize potential error. They must cultivate a culture that provides quality care to patients through teamwork and defined roles.

In addition, care management and coordination systems must be built across the entire healthcare system and community. Healthcare organizations will need to establish and nurture strong linkages to social service agencies to ensure better care management and coordination across the continuum, particularly to address community health needs.

4. Integrate Behavioral, Social and Physical Health

For healthcare organizations to improve the overall health of each patient, behavioral health and social determinants of health must be integrated with physical health. The design of the healthcare system must include resources and services to provide support for behavioral health and address social determinants of health, particularly in diagnosis, treatment and prevention.

5. Develop Collaborative Leadership

A successful care delivery system should include collaborative leadership structures with clinicians and administrators, along with a focus on leadership diversity. Creating collaborative leadership structures establishes shared goals and values that develop trust and reflect patient needs. It clearly identifies roles and aligns responsibilities to optimize efficiency and engage patients in their care. This sense of interdependence among leaders working together to achieve the Triple Aim is critical to better alignment and engagement. It is important for clinicians and hospital leaders to trust each other’s good faith and abilities.

6. Integrate into the Community

To effectively provide comprehensive healthcare, hospitals must be integrated into other aspects of their community. Connecting to surrounding community organizations and groups will create an enhanced delivery system capable of addressing today’s key factors influencing health and defining health outcomes.

To maintain a strong linkage with the community, the AHA proposes “Redefining the H,” also referred to in the following three actions:

• • Allocate resources and define a shared responsibility for improving community health.
  • Bring insight, perspective and support from the community into the hospital boardroom as hospital leaders consider paths for transformation.
  • Enter into strategic partnerships for improving community health and health outcomes.

7. Create a Safe and Highly Reliable Organization

By creating a culture of high reliability, healthcare organizations can better predict and manage risk and preventing catastrophic failures. According to Weick and Sutcliff in “Managing the Unexpected,” highly reliable organizations possess the following characteristics:

• • Consistently aware of how processes and systems affect the organization—leading to observations that influence decision making and new operational initiatives
  • Resist simplifications and conduct deeper examinations
  • Encouraged to think of ways their processes might break down and share their concerns for potential failures, which can help create best practices across all departments
  • Listen to people who have the most developed knowledge of the task at hand—regardless of hierarchy and seniority.
  • Prepared to respond to failures and find new solutions. Highly reliable organizations might experience numerous failures, but being proactive and building strong problem-solving capabilities prevent catastrophes.

Each of these principles characterizes the requirements of a new healthcare delivery system to meet the Triple Aim. In addition, hospital leaders must determine which payment model(s) will facilitate achieving these principles while also fitting them into the structure of their organization.