The Triple Aim, Nice but Not Nirvana

file000458994938Healthcare in America is changing rapidly. Exciting new advances in testing and treatment hold out hope for more effective, individualized and lower cost care. Insurance exchanges, although imperfect at present, are enabling individuals to select coverage based on their particular circumstances. Consumerism, price transparency, and new web-based shopping or comparison tools are helping to inform and shape purchasing decisions for healthcare services, major and minor. Bundled payment and value-based payment initiatives are forcing provider integration and improvement in quality, outcomes and service. From an insider’s viewpoint, it seems like everything is being upended. Really.

Changing is hard. Even positive change can be very difficult. When change is forced upon people, the usual responses include fear, anger, depression and other negative emotions. There’re a lot of negative emotions going around in healthcare these days. Many physicians, other providers, and healthcare leaders are having a tough time adapting to the rapidly evolving environment. However, despite the emotional turmoil (to which I am also subject), I’m generally optimistic about the outcome. Healthcare is going to get a whole lot better, but there are still at least several years of chaos ahead of us.

What’s it going to look like? Where are we going exactly? It’s hard to say for certain. The healthcare system in each community will likely look a little different from others, but from a national perspective, the Institute for Healthcare Improvement has popularized the “triple aim,” with the broad goals of: 1 – Improving the patient experience of care; 2 – Improving the health of populations; and 3 – Reducing the per capita cost of health care.  That seems quite doable to me.

I’m sure we’ll get there, but I’m also sure that this will not result in some health or healthcare nirvana.  I say this because I see so much utopian thinking in the media coverage of these developments. I’m sure you’ve seen it too: Life will be wonderful! All cancers will be cured! We will be able to replace your defective genes, and end aging! Maybe I exaggerate a little, but to me, many stories do suggest overly dramatic improvements for our future health.

There is no health utopia coming. Penicillin for streptococcal infection and insulin for type I diabetes were revolutionary in their day, saving affected patients from a quick death. Today we die of multiply resistant bacterial infections and type II diabetes, the former bred by our overuse, misuse and abuse of antibiotics, and the latter created from our persistently unhealthy lifestyles.

Some things will stay the same:

  1. Resources won’t be unlimited. The healthcare system will not meet everyone’s perceived needs. Some care will be denied, rationed or otherwise unavailable to most people, and those people will be angry.
  2. People will still get sick. Most illnesses will not be eradicated. New illnesses will arise. Complications of healthcare will still occur. And sick people will suffer – physically, emotionally and spiritually.
  3. Bad habits, poor choices, addiction, and plain accidents will still create a great deal of morbidity and mortality.
  4. People will still die.

The world is still a fallen place. Evil exists. Humans are still subject to the effects of sin, from within and without. We need to remember that. We need to remember it because it means that people will need more than “empowerment,” technology, and treatments. People will need connection, friendship, and companionship; also emotional support, encouragement, love and prayer. Most importantly, they’ll need the grace and peace that come only from God, just as they need them today.

Where will people find what they need beyond the ordinary in healthcare? How can we meet their (perhaps unstated and even unrecognized) emotional and spiritual needs? I think about that a lot, and I’m grateful to work at Florida Hospital, part of the Adventist Health System, where that kind of thinking is encouraged. And we’re not alone in that regard. Others, scattered here and there, are also striving to treat the soul inside, and I’ve been having many interesting conversations with physicians and healthcare leaders on this topic. I hope to write more about it as God reveals what he desires me to know.