Triple aim shouldn't miss the mark

Right care, right place, right time.

Ask any health policy wonk what modern health care is supposed to be about, and the person will recite that mantra.

The goal is to provide people with the appropriate level of care where it makes the most sense and without overly delaying treatment. The policy folks will say this "triple aim" is the key to reducing costs and improving quality.

The policy folks will say that's why it's so important to expand primary care services. Do that, and you've hit the bull's eye. You don't need to treat a sore throat in an ER. Because some health care problems (and some that masquerade as health problems but actually are caused by societal ills) can be addressed in a new model of care, primary care is moving toward the patient-centered medical home where other needs can be addressed. The approach is supposed to save patients – and by extension the system – money because you're saving the high-priced services for the high-needs patients.

Policy folks say the Three R's are supposed to benefit the patient. Based on some things happening in Rochester's health care system, I wonder whether the triple aim is more for the providers.

Competition is heating up, and you can pick your reason. Some point to health reform's payment changes that reward quality and economies of scale. Others say it's sandbox domination.

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