The well-known “triple aim” within the US healthcare system – to enhance the experience of healthcare, improve quality and reduce costs – got a big push in the direction of lowering costs with the announcement by CMS that goals are being set to move away from fee for service payment to outcomes based payments. Bending the proverbial cost curve, which has been heading upward every year (with few exceptions) for decades, was an agenda item left behind in the creation and deployment of the Affordable Care Act (Obamacare). With this new announcement, CMS has set concrete benchmarks which should augur well for innovation, and create further havoc among healthcare delivery providers and program designers and they scramble to find new ways to measure care outcomes and population health.
In some ways, establishing expectations without laying out a clear pathway to achievement may seem to be baiting the competition. After all, healthcare providers and payment intermediaries have been in antagonistic competition for many years. With a healthcare provider system so bent on generating more frequency (fee-for-service) and intermediaries bent on restraining frequency (managed care), how can we expect new, innovative models of collaboration.
Another challenge is that our highly partitioned healthcare system constructed around regulatory silos will need to quickly discover flexibility, agility and a new level of cross-platform collaboration and communication. A glaring example of this is the inability of pharmacists to work across the hospital, skilled nursing, home health care and retail venues without running afoul of multiple state and federal regulations, confusing formulary restrictions and licensing challenges.
And this is only a small example of what will need to be tackled if we are to achieve the triple aim.