Common Purpose

The Triple Aim Project looks to combine the forces of Memphis' mightiest healthcare providers and advocates.

Memphis’ Triple Aim Project is an ambitious undertaking that’s been developing for about a year. Its goal — to put together a much more integrated healthcare model for even the most vulnerable citizens in the community — is many-pronged and involves many influential people and organizations in the area. 

Among those are Stephen Reynolds, president and CEO of Baptist Memorial Health Care, and Gary Shorb, president and CEO of Methodist Le Bonheur Healthcare. In addition to his day job, Reynolds is chair of Memphis Tomorrow, an association of local CEOs that forges a relationship between the business community and government to spur economic growth. Memphis Tomorrow helps administer the initiative called Memphis Fast Forward, a strategic agenda to enhance local education, safety, government efficiency, and economic development. In addition to his day job, Shorb co-chairs Fast Forward with Memphis mayor A C Wharton and Shelby County mayor Mark Luttrell.

Triple Aim became the latest prong of Memphis Fast Forward in summer 2011. “The three goals [of Triple Aim] are improving the health of the overall population in Shelby County, providing greater access to care, and, once the patient has access, improving the experience of care,” Reynolds says. “The overall health of the population is critical to the viability of our city, especially our city’s ability to reach its full potential by facilitating strong economic and social progress.” 

At the same time, Triple Aim participants want to decrease costs. 

As is the case in other communities nationwide and around the world, Memphis’ Triple Aim originated with the Boston-based Institute for Healthcare Improvement (IHI), a think tank that’s been spreading its message of better healthcare delivery since about 2007. 

Dr. Scott Morris, founder and executive director of the Church Health Center (CHC), which provides care for the uninsured working poor, helped spur the initiative in Memphis last year when he penned an opinion piece for The Commercial Appeal. In his commentary, he wrote about IHI’s goal of creating regional coalitions for healthcare improvement. He also pondered what that kind of effort would look like in Memphis and Shelby County — and what it could actually do if successful. 

“It’s a very complicated idea to try to achieve, but hopefully there’s a simple and important solution for everybody,” Morris says.

Over the past several months, Morris and others have been discussing ways to make it happen. Part of the challenge is bringing together all of the major healthcare organizations in Memphis — Baptist, Methodist Le Bonheur, Saint Francis, and the Regional Medical Center — along with social-service and related agencies to reach consensus. 

Some of them include the Department of Human Services, county government, the nonprofit Healthy Memphis Common Table, and a host of others. Their collective idea is to create the infrastructure to support better, more integrated health delivery, and then to develop a common governance structure. Being able to measure outcomes also underpins the effort.

“How do you get it beyond just affecting a relatively small group of people so that it can have a citywide impact?” Morris asks. 

For example, the CHC is engaged in an 18-month-long program funded by BlueCross BlueShield of Tennessee’s (BCBST) health foundation to help 100 diabetic patients lose weight and keep blood glucose levels down. It’s one of many city or regionally focused efforts the organization funds, says Dr. Inga Himelright, BCBST vice president and Chief Medical Officer of commercial business and established markets.  

But if it’s successful, as many disparate healthcare-related efforts in Memphis have been, what might it mean for a much larger population? 

“The Triple Aim question is, how do you take it to scale?” Morris asks. “How do you take it to 5,000 people in Memphis [instead of just 100]?” 

Developing focus areas is one way Triple Aim participants have been zeroing in on that goal, says Dr. Kenneth Robinson, a former state health commissioner and Chief Health Officer, the current health policy adviser to Shelby County mayor Luttrell, and pastor at Saint Andrew AME Church in Memphis. Luttrell, Morris, and others tapped Robinson to help drive the Triple Aim forward and set the stage for the mayor’s “Healthy Shelby” initiative, which will be administered by Healthy Memphis Common Table.

One focus area important to the local community is chronic disease management. Another is end-of-life care, or what families can do when it comes to hospice or palliative care for ailing relatives. A big one, too, is infant mortality — for which Memphis has one of the highest rates in the nation. Fighting the issue branches into women’s health and family planning efforts, among other things. Between 40 and 50 local groups are or have been working to combat infant mortality.

“IHI says, ‘Don’t start from scratch. Assess your community,’” Robinson says. “By definition, this work is being done in multiple venues already.”

Part of what Triple Aim advocates is developing common metrics or measurements to gauge which programs enjoy the most success. Once that is established, it becomes a matter of applying those best practices across organizations and in a uniform manner. In the case of large local healthcare organizations beginning to collaborate, Robinson says that “has never been done.” So that alone is progress.

“What we’ve never done is link all those hospitals together so there’s some transparency to say, ‘How can we do this better and how can we all do what we need to do?’” he continues.

But now that new relationships are being built between organizations that traditionally have competed with one another for patients and resources, the goal becomes more possible. However, organizations have to be educated and so do patients, what Robinson refers to as “systematic intervention where there is collective will for collaborative action.” 

“That’s the key for Triple Aim,” Robinson says. 

It’s also a work in progress. Neither Robinson nor Morris could say when — or if — Triple Aim’s lofty goals will be accomplished. But against the backdrop of rising health insurance costs and national healthcare reform, many organizations and their executives have become more receptive to collaborating on solutions. That’s why employee wellness initiatives have been mushrooming in recent years. 

At the same time, healthcare costs have been rising between 8 percent and 10 percent a year, and employee absenteeism has been increasing too, making the issue one of “extreme relevance” to the corporate community, Robinson says. Plus, the federal Patient Protection Affordable Care Act of 2010 has “highlighted and heightened” expectations around primary care providers and preventive services.

Where once doctors were incentivized for the number of procedures they performed, by 2014, they will penalized for things like unnecessary or repeat hospital admissions for their patients. Plus, Medicare has created a new model for payment called value-based purchasing, in which payment flows from clinical results and patient experiences instead of the number of procedures or visits. It’s no secret, too, that doctors are expecting a 1 percent overall reduction in Medicare reimbursements by 2013.

But, as Morris says, only Memphis really understands the breadth of its own healthcare problems. Mandates from Washington or Nashville are all well and good, but reform is, at its heart, a local or bottom-up endeavor.

“We have made the pitch and Memphis and Shelby County have embraced the reality that we’re all in this boat together,” Robinson says. “We’ll survive together [or] we’ll sink together.”