An Overview of the Triple Aim

A framework to help healthcare systems optimize performance

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In 2007, the Institute for Healthcare Improvement (IHI) developed a framework for helping healthcare systems optimize performance using a variety of metrics. Since the framework uses a "three-pronged approach," the IHI called it the Triple Aim.

The Triple Aim's three areas of focus are:

  1. Improving patient experience
  2. Reducing the per capita costs of health care
  3. Improving the health of populations overall

Achieving the Triple Aim will be crucial to the success of healthcare organizations that are moving toward value-based payment systems. The Triple Aim also encourages healthcare leaders to use the strategies to improve the health of their communities beyond the hospitals and clinics that make up the healthcare system.

ihi triple aim drawing

While the Triple Aim has three components, they are not necessarily steps. Healthcare organizations should pursue all three prongs of the Triple Aim at the same time.

There are, however, several steps healthcare organizations can take leading up to implementation that will help make the transition go more smoothly:

  • Figure out the unique needs of the community and identify at-risk populations
  • Establish organization and system-specific goals
  • Develop a way to measure, track, and demonstrate progress

Improving Patient Experience

One of the primary goals of the Triple Aim is to improve the experience patients have when they are interacting with the healthcare system. In order to do this effectively and at the population level, healthcare systems need to assess the overall health of the communities they serve, identify any existing concerns or areas of risk, and assess overall mortality.

Additionally, there have been several initiatives over the last decade aimed at helping patients navigate the healthcare system more easily. This has included steps to improve communication between providers.

Electronic health records (EHR), Accountable Care Organizations (ACOs), and Managed Care Organizations (MCOs), Shared Decision Making , and patient-centered care coordination teams are just a few examples of the changes being implemented in healthcare systems throughout the United States.

Healthcare organizations can track the impact of these changes through patient satisfaction surveys and established quality improvement measures.

Reducing Cost

The United States has the most expensive healthcare system in the world, making up 17% of the gross domestic product (GDP). By 2020, that number is expected to reach 20%. While the cost of healthcare services is rising, the quality of those services is not.

In other parts of the world, healthcare systems have achieved a higher quality of care at a lower cost. Knowing this, the U.S. is motivated to increase the quality of the health care it provides while decreasing costs—but it's a complex balancing act. There are many factors that influence the quality and cost of health care in any nation, several of which are particularly burdensome in the U.S.

For one, the U.S. population is aging and developing more chronic health problems. Many are simply consequences of living longer. Countries with higher life expectancies must naturally contend with the chronic health conditions that afflict aging populations, many of which can be costly to diagnose and treat.

The cost reduction component of the Triple Aim encourages healthcare organizations to find ways to reduce the cost of the care they provide, while at the same time increasing quality, as well as identifying at-risk populations and addressing the health concerns of the community.

Improving Population Health

One of the key facets of the Triple Aim is the focus on identifying and addressing risk in communities. Everyone living in the community a healthcare organization is part of could potentially become a patient. Understanding what the most likely reasons would be for members of a specific population to engage with the healthcare system can help organizations preemptively develop strategies to offset costs and provide improved, patient-centered, and coordinated care.

The IHI made five recommendations to healthcare organizations that are in the process of designing new models of care to better serve their populations to help them achieve the interdependent goals of the Triple Aim:

  • Involve individuals and families when designing care models
  • Redesign primary care services and structures
  • Improve disease prevention and health promotion
  • Build a cost-control platform
  • Support system integration and execution

A Word From Verywell

The Triple Aim is a framework developed by the Institute for Healthcare Improvement (IHI) back in 2007 with the intention to assist healthcare systems in optimizing performance, reducing costs, and improving patient care through a variety of interventions and metrics. The rollout of these changes will occur over time and somewhat continuously until healthcare systems throughout the U.S. have adopted, implemented, and integrated them into care delivery.

As more healthcare organizations make progress in adopting the goals of the Triple Aim, evidence will help refocus the direction of the broader healthcare system in the United States. As has been the case for the last several decades, continued, sustained efforts to reduce cost, improve quality, and make care more patient-focused and better coordinated will likely remain priorities. The hope is that as more healthcare organizations within the system innovate and invest in improving these processes, it will inspire change throughout the entire system which will benefit patients, providers, and payers.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Institute for Healthcare Improvement. The IHI Triple Aim.

  2. Institute for Healthcare Improvement. Triple Aim for Populations.

  3. Institute for Healthcare Improvement. IHI Triple Aim Measures.

  4. National Learning Consortium. Shared Decision Making. Fact Sheet. December 2013.

  5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and costHealth Aff (Millwood). 2008;27(3):759–769. doi:10.1377/hlthaff.27.3.759

  6. Tandon A, Murray CJL, Lauer JA, Evans DB. Measuring Overall Health System Performance For 191 Countries. CPE Discussion Paper Series: No. 30. Worth Health Organization.

  7. Brown GC. Living too long: the current focus of medical research on increasing the quantity, rather than the quality, of life is damaging our health and harming the economyEMBO Rep. 2015;16(2):137–141. doi:10.15252/embr.201439518

  8. McCarthy D, Klein S. The Triple Aim Journey: Improving Population Health and Patients’ Experience of Care, While Reducing Costs. The Commonwealth Fund. July 22, 2010.

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