Chasing the Quintuple Aim: How health equity efforts benefit the entire system
More than 15 years ago, the Institute for Healthcare Improvement (IHI) developed the Triple Aim, a call to action for the healthcare industry to improve the patient experience of care, improve the health of populations and reduce the per capita cost of healthcare. This framework was later expanded to the Quadruple Aim, adding the goal of improving the provider experience in light of rising burnout.
Recently, physician leaders from the Institute for Healthcare Improvement (IHI) and National Academy of Medicine (NAM) advocated for the addition of a fifth aim: advancing health equity. Here’s what healthcare organizations can do to help actualize this vision, now called the Quintuple Aim:
Recognize that the five aims interconnect
When the Triple Aim was established, opponents argued that the individual aims inherently conflicted. Some thought improving the patient experience would increase costs, that reducing costs would create less healthy populations, and so on. Similar objections were raised with the addition of the fourth aim and may arise with the introduction of the fifth. However, health equity can coexist with the other four aims and even support them. And the COVID-19 pandemic illustrates this interconnectedness.
For example, we know from Centers for Disease Control and Prevention (CDC) data that American Indian or Alaska Native, Black or African American, and Hispanic or Latino people have more than double the risk of COVID-related hospitalization than white people. These inequities can have a ripple effect across the broader healthcare system. During pandemic surges, patients may delay procedures and unknowingly increase the cost of care if their conditions are not detected or treated in a timely manner. When hospitals reach capacity, clinician burnout may worsen due to the emotional toll of caring for patients with severe cases of COVID-19.
Initiatives targeting communities with unmet needs—like mobile testing sites or booster education campaigns—may not be delivered equally, but they can help ensure people with varied health resources all have good health outcomes. Understanding these intersections will help inform how your organization allocates its time and resources.
Decide where to start
While no organization can fix the whole healthcare industry, individual health systems and practices can certainly make a difference in their communities. People have unique needs, making it difficult to address all inequities simultaneously, but focusing on a few top priorities can help move the needle. And data is key in determining where to start.
Organizations can leverage public health and socioeconomic data collected by local municipalities and/or the state to establish where the greatest needs may lie. Electronic health record (EHR) data is another valuable resource in identifying risk among patient populations. Third, organizations should consider screening all patients for social influencers of health, as these factors are not always obvious. There are existing tools available, such as PRAPARE (the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences). Alternatively, organizations can add their own screening questions to their patient intake forms, as did Allscripts client Raleigh Pediatric Associates.
As a family medicine physician by training, I am a big proponent of preventative care, such as focusing on healthy diet and exercise. Keeping people well so they don’t progress to acute or chronic illnesses intersects with other aims like driving down costs, so focusing on this could be a great way to maximize your initial efforts. Ultimately, the data will help you determine what approach will deliver the biggest returns.
Take a holistic approach
We know most of a person’s health is shaped by what happens outside the four walls of a hospital or practice. To address issues like food insecurity and broadband access, healthcare organizations must establish relationships with community organizations that address your patients’ most critical needs. More solutions like community resource referral platforms are also coming onto the market, bridging gaps between health and social organizations to enable a true ecosystem of care.
For our part, Allscripts will continue developing and delivering solutions for clients and partners to build open, connected communities of health for everyone. The Quintuple Aim is a lofty ambition, but a worthwhile pursuit. And together, we can go farther.