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Pursuing the Triple Aim in a Higher Education Setting:
A Learning and Action Collaborative
Informational WebinarApril 30, 2018
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Agenda
� Introduction and Welcome
�Why Now?
�What Are We Working On?
�How Will We Work Together?
�Collaborative Activities, Timeline,
Expectations
�Questions
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SPONSOR
CONVENERS
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Expert Panel
Carlo CiotoliNYU
Allison SmithNYU
David FreedNYU
Aaron KrasnowArizona State Univ.
Lindsay PeaseConsolidated Health Plans
Sandra JohnsonRochester Institute of Technology
Harold PincusColumbia University & RAND Corporation
Niñon LewisIHI
John WhittingtonIHI
Afiesha McMahonIHI
Brandon BennetIHI
Matthew Guy IHI
Kim MitchellIHI
Catherine CraigIHI
Amelia ArriaUniv. of Maryland College Park
David ArnoldNASPA
Don GoldmannIHI
LZ GrandersonNYU
Richard KeelingKeeling & Associates, LLC
Martin MrozSimon Fraser University
Chris PayneCornell University
Jim SchausUniv. of Central Florida
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Today’s Presenters
Niñon Lewis, MSIHI
Afiesha McMahon, MHAIHI
Brandon Bennett, MPHIHI Faculty &
Carnegie Foundation Fellow
Matthew Guy, MPAIHI Faculty &
Accelerated Transformation Associates
Carlo Ciotoli, MD, MPANYU
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Why Now?
� Student health, mental health, and wellbeing are now
understood to be critical factors influencing learning,
retention, academic achievement, and overall
success
� Accountability for management of increasingly
complex and costly health issues on campuses
� Increasing diversity of student population; significant
health inequities
� Increasing resource allocation toward traditional
models for health, mental health, and health
promotion while still not meeting the need
� Increasing cost of tuition
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What Are We Working On?
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Definition of Population Health
“The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations, such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons.”
David Kindig,MD, PhD, and Greg Stoddart, PhD, American Journal of Public Health. March 2003.
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Population Health Approach
The aim of this broader approach is to improve health outcomes for a large population, with shared accountability and a commitment to addressing upstream determinants of health.
Saranya Loehrer, MD, Niñon Lewis, Molly Bogan. Improving the Health of Populations: The need for a common language is key. Healthcare Executive. MAR/APR 2016
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CHAT IN
Which populations
on your campus
are not thriving?
Be sure to send chat to “All Participants”
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Introduction to the Triple Aim
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Definition
System designs that simultaneously improve three dimensions:
- Improving the health of the
populations;
- Improving the patient
experience of care
(including quality and
satisfaction); and
- Reducing the per capita
cost of health care.
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Adoption and Application of Triple Aim in Diverse Settings
� Leading health systems
�Health plans
� Public and private employers
�Grassroots coalitions
� Social services agencies
�Geographic regions such as communities or even entire countries
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Getting Started on the Triple Aim
Aim: Apply the Triple Aim to a population served by your college or university.
� Choose a relevant Population for improved health, care and lowered cost
� Articulate a Purpose that will hold your stakeholders together
� Choose Measures that will show improvement for the population
� Develop a Portfolio (group) of projects that will yield Triple Aim results
� Identify and develop the Leadership and Governance for a Triple Aim effort
� Develop a brisk and realistic plan for Execution on projects and accountabilities for results
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The Triple Aim ina Higher Education Setting
�HOW programs and services are delivered is a major determinant of our students' health, experience, value, at every level across the institution…
�WHAT is delivered must include much more than health services and should address the underlying socio-ecological factors that impact health as well…
�WHO drives change critically determines how effectively our systems can meet the wants and needs of our students.
Creating our “best possible health…”
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Bus Pass $23 versus ED $1400
� “Member was seen in the ED 21 times in Dec.
2007.”
� “History of heroin use, transportation barriers to
receiving Methadone treatment and from seeing
her PCP on a regular basis.”
� “We bought a bus pass.”
� “No ED visits for two months and she is much more
engaged in CD treatment and her PCP
relationship.”
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What Does it Take to Pursue the Triple Aim?
�Creating the right foundation for population management.
�Managing services at scale for the population.
� Establishing a learning system to drive and sustain the work over time.
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How Will We Work Together?
LEARNING DESIGN AND ACTIVITIES
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The Typical Approach…
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The Quality Improvement Approach
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The Collaborative Method
A collaborative is a short term (approximately18-24 months) learning system that brings together multiple sites to seek improvement toward a common goal.
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How we will work together
(October 2018 – Winter 2021)
LearningSession
3
Winter
2020
LearningSession
2
Summer
2019
Virtual LearningCongress
Winter 2021ACTION PERIOD
1
LearningSession
4
Summer
2020
ACTION PERIOD
2
ACTION PERIOD
3
ACTION PERIOD
4
LearningSession
1
Winter
2019
Action Period SupportCoaching | Monthly Calls | Monthly Reports | Resource Center | Listserv | Data Support
Onboarding and Laying
the Foundation (begins October 2018)
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Model for Improvement
Source: Langley GL, Nolan KM, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition). San Francisco, CA: Jossey-Bass Publishers; 2009.
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GoalsIn collaboration with institutions of higher education and
subject matter experts, we intend to develop innovative
approaches to:
1. Accelerate the progress of colleges and universities on
their transformative journey in pursuit of the Triple Aim
2. Prototype innovative models in a higher education
setting to achieve the Triple Aim
3. Develop and test approaches to measuring the Triple
Aim dimensions of campus-level health and wellbeing,
students’ experience of care and services, and cost of
producing health – in a way that stimulates
improvement, reflects progress, and is balanced and
practical.
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Intended Results
Over this two year collaborative, partner
colleges and universities should be able to:
- successfully build a robust Triple Aim infrastructure
for measurement and improvement;
- define and advance key projects within their
portfolio to the level of measurable project results;
and
- some campuses will attain measurable progress on
all three dimensions of the Triple Aim, at least for
pilot populations of strategic importance.
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Collaboratives: “Have to Haves” for Accelerating Improvement
�Will – Motivation comes from learning that it is possible and from bonding with colleagues working on the same problem.
� Ideas – Acquire great ideas for change using the evidence base, tried and tested changes, faculty, and colleagues
� Execution – Learn a method for making lasting changes and begin using it
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Will: Senior Leadership Support
Campus leaders see that the Triple Aim is, or will be, strategic for their institution.
Leaders should stay actively connected to the improvement work of the collaborative.
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Ideas: Example Areas of Focus
� Emotional Distress and Mental Illness
� Prevention of High Risk Substance Use and Substance Use Disorders
� Health Literacy
� Preventive Services (e.g., immunization, screenings)
� Health Behaviors (e.g., diet, exercise, tobacco cessation)
�Wellbeing (e.g., resilience, purpose, acceptance, social connections)
� Health Impediments to Learning and Academic Achievement
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CHAT IN
Identify potential partners to engage in efforts to improve student health, mental health, and wellbeing on your campus.
Be sure to send chat to “All Participants”
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Examples of Triple Aim Measures*Dimension Measure
Population Health 1. Health Outcomes:
� Mortality: Years of potential life lost; Life expectancy; Standardized mortality rates
� Health/Functional Status: single question (e.g. from CDC HRQOL-4) or multi-domain (e.g. SF-12)
� Healthy Life Expectancy (HLE): combines life expectancy and health status into a single measure, reflecting remaining years of life in good health
2. Disease Burden: Incidence (yearly rate of onset, avg. age of onset) and/or
prevalence of major chronic conditions
3. Risk Status: Behavioral risk factors include smoking, alcohol, physical activity, anddiet. Physiological risk factors include blood pressure, BMI, cholesterol, and blood
glucose. (possible measure: a composite Health Risk Appraisal (HRA) score)
Experience of Care
1. Standard questions from patient surveys, for example:
� Global questions from US CAHPS or How’s Your Health surveys� Experience questions from NHS World Class Commissioning or
CareQuality Commission
� Likelihood to recommend
2. Set of measures based on key dimensions (e.g., US IOM Quality Chasm aims:
Safe, Effective, Timely, Efficient, Equitable and Patient-centered)
Per Capita Cost 1. Total cost per member of the population per month
2. Hospital and ED utilization rate and/or cost
*Measures for this Collaborative will tailored to the student population and higher education setting
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Collaborative Activities
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How we will work together
(October 2018 – Winter 2021)
LearningSession
3
Winter
2020
LearningSession
2
Summer
2019
Virtual LearningCongress
Winter 2021ACTION PERIOD
1
LearningSession
4
Summer
2020
ACTION PERIOD
2
ACTION PERIOD
3
ACTION PERIOD
4
LearningSession
1
Winter
2019
Action Period SupportCoaching | Monthly Calls | Monthly Reports | Resource Center | Listserv | Data Support
Onboarding and Laying
the Foundation (begins October 2018)
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Collaborative Improvement Process
Learning Session 1
Clarify your aim
Get Ideas
Get Methods
Get Started
Learning Session 4
and Beyond
Celebrate
Successes
Get ready to
Sustain and Spread
Learning Session 2-3
Get More Ideas
Get Better at
Methods
Get a “Stride”
Action Period
Test & implement all changes
Action Period
Test all changes on small scale
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Timeline: Program Activities
Fall '18Winter
'18/'19
Spring
'19
Summer
'19Fall '19
Winter
'19/'20
Spring
'20
Summer
'20Fall '20
Winter
'20/'21
Onboarding and Laying the
Foundation Calls�
Learning Sessions
� � � �
Virtual Learning Congress
�
Monthly Reporting
� � � � � � � � �
Monthly All-Team Call
� � � � � � � � �
Improvement Coaching Call
� � � � � � � � �
*Timeline is based on the calendar year seasons, not semesters.
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Expectations of Participating Sites� Triple Aim is a strategic priority supported at the senior level (at the level of VPSA or above)
� Meaningful populations (or segments) can be identified for improvement
� Key partners will need to be engaged
� Commitment to developing:
- data capabilities to generate measures for all elements of the
Triple Aim
- skills in executing improvement initiatives
� Resources are dedicated to driving progress on the site’s Triple Aim project portfolio (project management, data analyst,
executive oversight, etc.)
� Participating fully in collaborative activities (monthly reports, Learning Sessions, all team calls)
� All teach, all learn, all lead
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Support For Participating Sites
�Customized guidance and coaching from expert faculty:
- setting up your Triple Aim portfolio of projects
- using the Model for Improvement to test,
implement, and scale up sustainable improvements
� Support around measurement strategies
�Access to an Online Resource Center
� Receive individualized feedback on your team’s improvement progress
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Enrollment
�Competitive application process; selection on a
rolling basis; limited number of spots available
� Process
1. Submit application (available May 7)
2. Conversation with members of the Collaborative Expert Team
3. Submit institutional letter of commitment (standard template provided) from the Chief Student Affairs Officer, or equivalent position
� Enrollment closes on September 13, 2018, or when
all spots are filled to capacity -- whichever
happens first
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Together, we will…
LEARN.
We will generate new understanding of how to improve the health of students not thriving, while exploring the value proposition for institutions of higher education tobalance focus on both upstream factors and downstream outcomes and consider the overall trajectory of health and wellbeing.
NETWORK.
We will share successes and failures to accelerate our journey in pursuit of the Triple Aim. We will collaborate with expert faculty and each other to leverage the synergies of our collective knowledge, skills, and experiences. We will test strategies for co-producing Triple Aim improvements with diverse disciplines and students on our campuses.
IMPROVE.
We will strengthen our quality improvement capability and capacity and use a structured process to advance transformational change at scale. We will develop and track “measures that matter” to assess our progress, benchmark, and drive continuous improvement.
LEAD.
We will be at the forefront in leading within and across our institutions to test innovative paradigms that improve health, wellbeing, and health equity of our students at lower cost while developing new knowledge toinform the field.
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Thanks for Joining Us!Questions? Email [email protected]
More information and apply* at:collegehealthqi.nyu.edu/triple-aim *The application will available beginning May 7