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The Four Elements of the Quadruple Aim


The Institute for Healthcare Improvement first created the Triple Aim to summarize the key challenges identified in the U.S. healthcare system over the prior four decades. The analysis looked at how to deliver the best patient care possible to the greatest population of people at a sustainable cost. The importance of the healthcare team was later added as an additional critical element to delivering exceptional patient care; hence, the Quadruple Aim was created.

The Quadruple Aim serves as an organization’s roadmap for delivering high-quality care. The Centers for Medicare and Medicaid Services (CMS) also uses these aims as areas of focus for value-based care. The key elements for an organization to focus on are delivering the highest quality patient care in the most cost-efficient manner with the best patient experience and an empowered care team.

Aim One: Improving the Health of the Population

Care-at-home organizations are focused on improving the health of their population of patients, starting with the initial admission and assessment, their ongoing care and ultimately their transfer or discharge. By focusing on patient-specific needs, including connecting them to resources in the community to help with social determinants of health, an organization can ensure quality patient outcomes.

Aim Two: Improving the Patient Experience

When healthcare organizations empower patients to become more involved in their care and improve their overall experience, data demonstrates that patient outcomes improve and costs of care decrease. Other factors that care-at-home organizations can look at that can improve the patient experience include additional communication through a patient portal that can provide reminders and visibility for progress on goals and care, caregiver matching and using preventative care measures. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is an objective tool for measuring patient experience.

Aim Three: Reducing Costs

The focus of delivering cost-effective care ensures an organization optimizes their workflow and processes to maximize their resources and meet patient needs. Delivering cost-effective care does not always involve spending less but seeking to offer the best value while still achieving optimal patient outcomes. For example, with clinician visit utilization and resource optimization, nurses can call or complete telehealth visits with high-risk patients between regular visits to monitor and identify problems that can be addressed before they escalate or lead to acute complications.

Aim Four: Improving Care Team Wellbeing

It is important for organizations to ensure staff are aligned around addressing patient needs to achieve the other three aspects of the Quadruple Aim. Empower staff, especially clinicians, to practice to the full extent of their license and training, and eliminate any technology barriers hindering their ability to deliver care. Try minimizing the staff’s administrative overhead and optimizing their visit schedules. These are crucial steps to avoid burnout. When recruiting new staff, look for people who are going to be a strong fit for your company culture. When staff express any safety concerns, listen to them and take noticeable action. These steps will help keep staff engaged with your organization and better able to deliver quality care.

The CMS focus on delivering quality care, especially as outlined by the Quadruple Aim, will help organizations remain successful in the long term. Organizations that create a culture focused on all aspects of the Quadruple Aim will continually deliver quality care.

Axxess offers home health, home care, hospice and palliative care cloud-based solutions that empower clinicians with point-of-care documentation and patient-specific plans of care.

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