The Triple Aim – optimizing health, care and cost


United States healthcare costs far more and results in poorer overall population health when compared to other nations. ‘Despite spending on health care being nearly double that of the next most costly nation the United States ranks thirty-first among nations on life expectancy, thirty-sixth on infant mortality, twenty-eighth on male healthy life expectancy and twenty-ninth on female healthy life expectancy.’1

The fragmented nature of the current health system, where different providers often have differing incentives, leads to suboptimal treatment, patient dissatisfaction, and inefficiency. Finding better ways to deliver value from the resources invested in healthcare is not a new dilemma, but when providers have different incentives, moving forward can be complex. 

The IHI’s Triple Aim Framework guides the development of new healthcare models. According to the Triple Aim, all new healthcare designs must be developed to simultaneously:

  • improve the health of a population
  • improve patient experiences
  • reduce costs.

The IHI also provides some guidelines ( for translating the framework into specific actions, including:

  • a focus on individuals and families
  • redesigning primary care services and structures
  • a focus on the health needs of specific populations (e.g. people with chronic wounds)
  • a cost-control platform
  • system integration and execution.

The concept also includes roles for providers who can integrate the resources of numerous organizations across the continuum of care. Read more

The Triple Aim and Chronic Wound Care

The US health system, with its strong focuses on acute episodic care, struggles to meet the needs of those with chronic conditions. Healthcare providers who are adopting electronic wound management (EWM) systems around the world are demonstrating how the Triple Aim can be achieved in wound care. These providers are able to show:

    • EWM being used to improve wound documentation and management, making it easier for organizations to improve their capabilities, reduce risks and enhance patient satisfaction.

    Kaiser Permanente, USA

    Barlow Respiratory Hospital, California, USA

    Parkview Medical Center, Colorado, USA

    Southern District Health Board, New Zealand

    • Increases in patient engagement and compliance, leading to improved healing, which has the follow-on effect of reducing costs.

    Capital and Coast Health, New Zealand

    Southern District Health, New Zealand

    Christchurch Diabetes Centre, New Zealand

    • Telehealth and community-based wound care solutions that are reducing the load on more costly care settings while improving patient care and experiences.

    TED, across the United States

    EMAHSN & Entech Health, Derbyshire, United Kingdom

    Townsville Hospital, Australia

    Many healthcare agencies have already or are in the process of introducing new models of care and initiatives and behaviors aligned with the Triple Aim. ‘The remaining barriers are not technical; they are political. The superiority of the possible end state is no longer scientifically debatable. The pain of the transition state – the disruption of institutions, forms, habits, beliefs, and income streams in the status quo – with what denies is, so far, the enormous gains on the components of the Triple Aim that integrated care could offer.’ (Berwick et al.)

    Is your organization ready to pursue the triple aim?


    1. Berwick D.M., Nolan T.W. & Whittington, J. (2008) The Triple Aim: Care, Health, and Cost, in Health Affairs, Vol 27, No. 3.
    2. Institute for Healthcare Improvement, (2009) ‘The Triple Aim: optimizing health, care and cost’ Link
    3. Center for Connected Health Policy: the National Telehealth Policy Resource Center, (September 2014) ‘Recommendations from the CCHP Telehealth and the Triple Aim Project: Advancing Telehealth Knowledge and Practice’


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