TRICARE Presents Quadruple Aim

By David Loebsack
Health.mil

January 27, 2010 - The “Triple Aim” is a phrase that is often discussed in the health care community. It’s an idea that refers to the three integral factors that determine the overall quality of health care: population health, positive patient experience, and per capita cost.

Adm. Christine Hunter, the deputy director of TRICARE Management Activity, has taken this health care paradigm and added a necessary fourth determinant – readiness – in order to adapt it to Military Health System use. She gave a lecture regarding the MHS’s “Quadruple Aim” during the 2010 MHS Conference, on Jan. 26.

Hunter opened by discussing the sheer size of TRICARE’s operations: 59 hospitals and medical centers, 364 health clinics and roughly 350,000 individual providers serving a beneficiary population of 9.6 million. She also talked about the massive numbers of processes that are being initiated on a regular basis: roughly 22,000 inpatients admitted, 2.5 million prescriptions written and 3.5 million claims being processed every week.

Because TRICARE handles such a vast array of needs in the military medical community, its ability to remain on target in achieving these four goals is foundational in maintaining an effective and efficient system, to keep the U.S. Armed Forces fit to fight.

She began by comparing TRICARE patient costs with similar federal Blue Cross Blue Shield standard and Kaiser HMO plans, showing that over a period of nine years TRICARE has consistently required less cost-sharing from its patients.

She also showed that readiness has steadily grown in the total force for four consecutive quarters. Although there was initial cause for concern beginning in 2007, with an increase in behavioral diagnoses, the MHS responded with a 20 percent surge in mental health providers. Since 2008, behavioral health locator lines have also helped address this burden, serving more than 20,000 men and women, and helping increase the overall capacity of services rendered.

Hunter went on to cite the Enrollee Preventive Health Quality Index to track population health showing that health outcomes have also been on a steady rise since 2007. In fact, the MHS is ahead of target for 2010 thanks to an increase in preventive measures.

Her plan for improving the quality of health care included enhancing the patient experience, streamlining the emergency room product line and incorporating the medical home model – which places a high emphasis on patient centered care, team-based delivery and population health.

In closing, Hunter said that TRICARE is ready for change. Maximizing readiness, focusing on outcomes, and achieving sustainable costs are the end-goals, but in order to get there, Hunter called on everyone in the system to be facilitators and incentivizers.