The Institute for Healthcare Improvement (IHI - www.ihi.org) has developed a framework for improving healthcare called the Triple Aim.  The framework defines the need to simultaneously focus on the following three measures when driving improvements:

• Improving the Patient Experience of Care,
• Improving the Health of Populations, and
• Reducing the per capita cost of healthcare

Implementing the Triple Aim in Home Care

I believe that Home Care can play a central role in helping the health care system achieve the triple aim, by following this recipe:

1. Measure your readmission rates by disease state and establish your agency as a leader in reducing readmissions
2. Use your success in step 1 to partner with hospitals in providing a Readmission Reduction program.  This should target 30 day readmission rates for Congestive Heart Failure (CHF), Pneumonia, Heart Attack (Acute Myocardial Infarction), Chronic Obstructive Pulmonary Disease (COPD), Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA).  This will put you ahead of the curve in reducing readmissions.  Note that Ankota offers software for managing care transitions.
3. Partner with Accountable Care Organizations (ACOs) to provide ongoing care services to avoid admissions for their most expensive patients.  Do this in two stages, as follows: First focus on the most expensive patients, the 5% of the population that accounts for 50% of healthcare costs.  By having a nurse case manager check in regularly with the patient via telehealth and phone calls, admissions can be avoided.
4. Next, encourage the ACO to continuously examine their patient population through data mining to identify patients likely to present in the expensive five percent.  For these patients, conduct a health screening visit to identify those patients who could benefit from your ongoing care program.

By following this recipe you will help achieve the triple aim as follows:

• Hospital admissions (the most expensive form of care) will be reduced, thus lowering the cost of care
• By keeping patients out of the hospital and communicating with them regularly, you'll increase their quality of care (and quality of life)
• By focusing on the most medically vulnerable population and those most likely to present in that population, you'll be improving the health of populations

To Learn more about IHI including a video with examples of organiztion implementing the triple aim, click on the image below:

To learn more about running a care transitions program and about Ankota's care transition software, press the button below:

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.