Although the chronological format of the cases is sometimes too linear and overly detailed, Pursuing the Triple Aim ultimately succeeds. The issues and opportunities tackled in the book are diverse, and many echo the high-impact hierarchy suggested in Flower’s book. The cases include diabetes management for patients of an HMO, improvement of costs and outcomes for a state Medicaid population, experiments in moving away from fee-based medicine, and the reengineering and reimagining of end-to-end care for high-cost but high-volume procedures such as joint replacements.
For healthcare executives charged with tackling care improvement, the here-and-now, been-there-done-that tone should be motivational. The deck is a bit stacked because almost all of the cases are drawn from highly integrated provider systems (doctors and hospitals operating under one organizational umbrella) with a history of being paid via some kind of set fee per member, as opposed to the traditional fee-for-service model. This will make it somewhat harder for less-integrated provider systems to mimic the scenarios in the book, but it shouldn’t be a major drawback because virtually all healthcare delivery systems have been moving toward greater integration of physicians and hospitals over the last decade.
Perhaps the most compelling case, involving the Virginia Mason Medical Center in Seattle and Intel Corporation, illustrates the potential of major employers working with their biggest healthcare “suppliers” to control costs and improve care. Building on a small-scale effort aimed at reducing costs and absenteeism due to minor lower-back pain among Starbucks employees, Virginia Mason and Intel, both experienced and committed lean organizations, used two simple questions to create the foundation for a new delivery system for back patients. Virginia Mason asked, “What do our customers want?” and Intel asked, “Why don’t we buy healthcare as rationally as we source everything else we need?” Their goals for back pain patients were ambitious: They wanted complete patient satisfaction, same-day access, rapid return to function, and 100 percent use of evidence-based medicine in every case.
The journey taken together by Virginia Mason and Intel to achieve these goals was complex, and it involved more and more players as it evolved, including multiple markets, new providers, and insurers. It has a happy ending, of course, and the process used can be replicated to improve systems and treatments for other high-volume conditions, such as depression, diabetes, and abdominal pain.
The authors share analytical techniques, organizational approaches, metrics, and inspirational vignettes in each of the case studies. But these studies are first and foremost lessons in the need to focus on goals rather than tools. Other how-to books generally shoot too low — imparting skills, but too often aiming at minor targets. Pursuing the Triple Aim shoots higher and hits its mark.
There will be a lot of “gee-whiz” advances in the science and technology of healthcare in the coming decades. But as wonderful as that future promises to be, we will never see its true value if we don’t address the structural, moral, and operational challenges burdening our current healthcare system. Each of this year’s best business books on healthcare is a real contribution toward making that better future more likely.
- J. Philip Lathrop is a senior executive advisor with Booz & Company, specializing in the improvement of healthcare delivery, and the author of Restructuring Health Care: The Patient-Focused Paradigm (Jossey-Bass, 1993).