登录查看更多内容

How do you apply the Triple Aim framework to UM?

由人工智能和领英社区提供技术支持

Utilization management (UM) is the process of ensuring that health care services are appropriate, effective, and efficient for patients. UM can help improve the quality, access, and cost of care, which are the three goals of the Triple Aim framework. The Triple Aim framework, developed by the Institute for Healthcare Improvement (IHI), is a widely adopted model for optimizing health system performance. In this article, you will learn how to apply the Triple Aim framework to UM and how it can benefit your organization and your patients.

此文章中的业界达人

由社区从 3 条内容中精选。了解更多

1 The Triple Aim framework

The Triple Aim framework consists of three interrelated dimensions: improving the health of populations, enhancing the experience of care, and reducing per capita costs of care. The framework suggests that achieving these goals requires a coordinated effort among health care providers, payers, policymakers, and communities. The framework also emphasizes the importance of measuring and monitoring outcomes and processes across the three dimensions.

添加您的观点

Jason Kessler, MD, FAAP, CMQ

Physician executive focusing on Quality, Innovation, Collaboration | Medical Director | Quality Leader | Process Improvement Innovator | Medical Educator | Pediatric Expert | #MedicalQuality #Pediatrics #JoyInWork
举报内容
Some sources now recommend a quintuple aim, which adds improving health equity and improving the healthcare worker experience. While not necessarily part of the IHI focus, interventions that keep these additional points in mind will increase the success of health care improvement.

已翻译

赞

2 Applying the Triple Aim to UM

Applying the Triple Aim framework to UM requires aligning policies, procedures, and practices with the three dimensions. For example, UM can be used to identify and address the needs and risks of specific patient groups, such as those with chronic conditions or complex comorbidities. It can also promote preventive and wellness services, ensure timely and appropriate care that meets patient preferences and goals, reduce unnecessary or harmful services, facilitate care coordination and communication among providers, patients, and families, optimize the use of resources, incentivize value-based care, and evaluate the cost-effectiveness and quality of care provided by different providers.

添加您的观点

Jason Kessler, MD, FAAP, CMQ

Physician executive focusing on Quality, Innovation, Collaboration | Medical Director | Quality Leader | Process Improvement Innovator | Medical Educator | Pediatric Expert | #MedicalQuality #Pediatrics #JoyInWork
举报内容
The triple aim has been compared to a 3-legged stool. The stool will not stand if UM focuses just on improving the cost of care, which has been its traditional focus.

已翻译

赞
Sid Raghavan MD, FACP, CHCQM, CPE

Physician Executive | Utilization Management | Hospital Medicine
举报内容
I would reverse this framework by suggesting the application of sound UM practices to achieve healthcare reform goals as defined by the Triple Aim. A prime example is developing UM strategies - follow up appointments, post-acute navigators, project BOOST, project RED, meds in hand, goals of care etc. - to reduce avoidable readmissions, thereby improving quality and decreasing the cost of care.

已翻译

赞

3 Benefits of applying the Triple Aim to UM

Applying the Triple Aim framework to UM can have several benefits for your organization and your patients. These include improved quality and safety of care, increased patient satisfaction and engagement, as well as enhanced organizational performance and reputation. UM can help ensure that patients receive the right care at the right time and place, thus improving clinical outcomes and reducing the risk of errors. Additionally, involving patients in their care decisions can increase their trust and loyalty, as well as improve their satisfaction with their care experience and their quality of life. Lastly, by achieving the Triple Aim goals, you can improve your financial sustainability, efficiency, and competitiveness while also enhancing your reputation as a high-quality, low-cost, and patient-centered provider or payer.

添加您的观点

4 Challenges of applying the Triple Aim to UM

Applying the Triple Aim framework to UM is not without challenges. Common issues include balancing competing priorities and interests, implementing and sustaining change, and measuring and demonstrating impact . Trade-offs or conflicts among the three dimensions of the Triple Aim, such as between quality and cost, may arise. Additionally, you may need to invest in infrastructure, technology, data, and workforce to support UM and the Triple Aim. Furthermore, you may find it difficult to measure and report on the outcomes and processes of UM and the Triple Aim. As such, a culture of continuous improvement, learning, and collaboration is essential for success.

添加您的观点

5 Tips for applying the Triple Aim to UM

Maximizing the benefits of applying the Triple Aim framework to UM requires overcoming certain challenges. To do this, you must have a shared vision and strategy that aligns with the Triple Aim. Engaging and empowering stakeholders is essential, as is adopting best practices and evidence-based guidelines. Additionally, you must be open to innovation and adaptation to changing needs. This will help ensure that your UM policies, procedures, and practices are up-to-date and effective in meeting the Triple Aim goals.

添加您的观点

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

添加您的观点

Utilization Management

+ 关注

给文章评分

我们借助人工智能创建了此文章。您认为这篇文章怎么样？

很棒不太好

举报此文章

查看全部

How do you apply the Triple Aim framework to UM?

1

2

3

4

5

6

1 The Triple Aim framework

2 Applying the Triple Aim to UM

3 Benefits of applying the Triple Aim to UM

4 Challenges of applying the Triple Aim to UM

5 Tips for applying the Triple Aim to UM

6 Here’s what else to consider

Utilization Management

给文章评分

感谢您的反馈

更多Utilization Management相关文章

更多相关阅读内容