Hospital leaders are working to redesign care delivery systems, using payment models that center on individual and community needs.

Innovative approaches will help hospitals and health systems to achieve the Triple Aim: improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of health care.

“Care and Payment Models to Achieve the Triple Aim,” released jointly by the 2015 American Hospital Association Committee on Research and the 2015 AHA Committee on Performance Improvement, describes principles and payment models to move hospitals and health systems forward in a changing environment.

Seven key principles

The 2015 AHA Committee on Performance Improvement studied design and redesign of the care delivery system and identified seven key principles.

Each principle characterizes requirements for a care delivery system to meet the Triple Aim:

  1. Design the care delivery system with the whole person at the center.
  2. Empower people and the care delivery system itself with information, technology and transparency to promote health.
  3. Build care management and coordination systems.
  4. Integrate behavioral health and social determinants of health with physical health.
  5. Develop collaborative leadership.
  6. Integrate care delivery into the community.
  7. Create safe and highly reliable health care organizations.

Transformational change that is occurring in the health care system is focusing on value, meeting patient needs while promoting good health. These principles move hospitals and health systems toward this aim.

With the rise of consumerism, retail clinics and digitalization, a new stage of health care is emerging — one in which individuals will want more control and transparency related to their health care choices and will have a greater financial stake in choosing the right care for their needs.

Innovative payment models

The 2015 AHA Committee on Research discussed redesigning the payment system for patient care. As health care transforms, several new payment models have emerged, all of which derive from one of three fundamental approaches: service-based, which is predicated on the fee-for-service mechanism; bundled-based, which aggregates different services and providers; or population-based, which aggregates total care and costs across the continuum. Critical to any model are incentives related to value, teaching, the patient population’s socioeconomic status and transition support.

As hospitals and health systems implement new payment models, short- and long-term policies are needed to target stress points that can impede the movement to value-based care. Stress points include obtaining available data; supporting the infrastructure and bridge between payment models; and getting better tools and methods, such as risk adjustment, that more accurately reflect the intended design of payment models.

Critical to overall success is for health care leaders to select the clinical and payment models that work best for their organization and community. The AHA report highlights case examples from hospitals and health systems across the United States that are using innovative approaches.

To read “Care and Payment Models to Achieve the Triple Aim" and access related resources, visit www.aha.org/research/cor/care-payment/index.shtml

Michael G. Rock, M.D., chair of the 2015 AHA Committee on Research, is chief medical officer at Mayo Clinic Hospitals/Mayo Foundation, Rochester, Minn. Thomas W. Burke, M.D., chair of the 2015 AHA Committee on Performance Improvement, is executive vice president of the University of Texas MD Anderson Cancer Center, Houston.