In the early 2000s, Institute for Healthcare Improvement (IHI) established a goal for health systems known as The Triple Aim of Health Care: the pursuit of a positive patient experience, positive health outcomes and low spending. A new study released by The Lancet examines U.S. counties that have been the most successful in achieving the Triple Aim and details successful policies that could be valuable for developing policies that improve health care nationwide.
Currently, the U.S. health care system has high rates of health spending and poor health outcomes, relative to other countries, although the study notes there is substantial variation within the country at both state and county level.
The study combines county-level data on each component of the Triple Aim to assess health care system performance from 2014-2019. For each county, overall unadjusted performance scores were generated from data on each of the three aims. Additionally, adjusted performance scores were then calculated which were controlled for key county characteristics outside of the control of the health system.
The study revealed that counties with higher unadjusted performance scores tended to have populations that were more educated, wealthier, had a higher proportion of residents in urban households, lower rates of obesity and lower rates of smoking than counties with lower scores.
After county scores were adjusted for these underlying characteristics, the study found that counties in Rhode Island, Iowa, Idaho, Virginia and Hawaii led in progress towards the Triple Aim. Meanwhile, counties in the District of Columbia, Alaska, Delaware, Mississippi and Oklahoma had the lowest scores.
In terms of policy-relevant factors, progress towards the Triple Aim was associated with a prioritization of managed care, expanded Medicaid coverage, and competitive hospital and insurance markets.
According to the study, these findings further highlight health system disparities and policies that were associated with health care system performance. These results can help policy makers develop strategies that reduce health care spending, increase access to and quality of care, and ultimately improve health outcomes.
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