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These lessons come from our own experience and discussions with physicians and other actuaries.Īn outlier in health care often refers to specific patient data exhibiting unusual cost and/or outcomes. In the following sections, we share lessons learned about the means of addressing the high cost of health care. Positive physician and patient engagement.Creative and effective use of information.Ability to prove and sustain material savings.This article will describe generally how these approaches work and rank their effectiveness based on the following criteria: Health risk takers of all types (ACOs, government health care sponsors, employers, and private insurers) are each experimenting with these approaches. Adopting physician-driven value-based care.Channeling as much care as possible inside the contracted network.Applying payer-sponsored health care interventions.Implementing change through formal quality improvement efforts.Leveraging the electronic medical record (EMR).Note that these are not mutually exclusive activities as some tend to overlap with one another: In terms of lowering per capita cost, we will focus on six broad approaches to the challenge. We have, however, tried to offer some general approaches that we believe work in a variety of such situations. These entities operate in multiple markets under a wide variety of financial circumstances consequently, it is impossible to offer a cookbook that works in every circumstance. Our target audiences are actuaries, finance leaders, and administrators who work with employers, payers, Accountable Care Organizations (ACOs), health systems, and at-risk provider entities. This article is concerned with techniques and strategies aimed at the per capita cost dimension but not at the exclusion of the other dimensions. More recently, provider well-being has been added to form the fourth point in what some commentators see as the now quadruple aim. The triple aim was first described in 2008 and recognizes that improving the United States health care system requires simultaneous advancement in three dimensions: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

The Quadruple Aim in health care is a recent adaptation of an earlier concept: the triple aim.