Developing a dashboard to help measure and achieve the triple aim: a population-based cohort study

Area of Science:

• Health Services Research
• Health Informatics
• Public Health

Background:

• Health system planners strive to achieve the Triple Aim: reduced costs, improved population health, and enhanced care experience.
• Effective health system management requires reliable measures to predict future healthcare needs.
• Current measures for assessing the Triple Aim and predicting future needs at a health system level are limited.

Purpose of the Study:

• To explore the application of a case-mix adjustment method for measuring and improving health system performance aligned with the Triple Aim.
• To assess the utility of a case-mix adjustment system in evaluating health system performance and the Triple Aim.

Main Methods:

• A retrospective cohort study analyzed administrative data from 11.4 million adults in Ontario, Canada.
• The Johns Hopkins Adjusted Clinical Group (ACG) Case-Mix System was used to assign individuals to 60 healthcare need levels (ACGs) based on 2008 diagnoses and utilization data.
• Actual healthcare utilization and costs in 2009 were assessed, forming a health system dashboard with measures of individuals per ACG, total system costs per ACG, and mean cost per person per ACG.

Main Results:

• The study identified significant variations in healthcare utilization and costs across ACG categories, with the highest acuity group consuming 12 times more resources than average.
• The sickest 1%, 5%, and 15% of the population accounted for approximately 10%, 30%, and 50% of total health system costs, respectively.
• The developed dashboard effectively measures reduced costs and improved population health (shift towards healthier ACGs), with potential to improve care experience through predictive utilization reporting.

Conclusions:

• A case-mix dashboard, derived from case-mix methods, effectively measures two key goals of the Triple Aim: cost reduction and population health improvement.
• This dashboard provides health system planners with valuable insights for better management of health delivery systems.
• The system's predictive capabilities can support proactive care planning, contributing to the third Triple Aim goal of improved care experience.