By Kam Reams & Alan Little
The Triple Aim is the backbone of healthcare reform; however, there are barriers to effective system-wide change that must be addressed before we can seize opportunities for improving the health of individuals and populations while reducing costs. Long-standing operational silos make realizing positive reform an extremely difficult endeavor. By addressing these silos and transforming the existing model of healthcare delivery, we can begin to realize the objectives of the Triple Aim.
The Silo Mentality
A primary barrier that stands in the way of achieving the Triple Aim is “silo mentality.” According to the Business Dictionary, silo mentality is defined as:
“A mindset present when certain departments or sectors do not wish to share information with others in the same company. This type of mentality will reduce efficiency in the overall operation, reduce morale, and may contribute to the demise of a productive company culture.”
Unfortunately, silos are inherent to the way the healthcare system is currently structured and the effects of this mentality have had adverse impacts on the health of the US population.
A recent Silos to Systems assessment conducted by the Centers for Disease Control and Prevention (CDC) of the implementation of the National Public Health Performance Standards (NPHPS) to improve the quality of public health practice and performance found that there was significant activity reported by organizations across the nation related to each standard. However, the majority of this work was occurring in silos (individual efforts), not in systems. This observation is alarming and confirms that silos interfere with the goals of the Triple Aim.
How Silos Disrupt the Healthcare System
The silo mentality presents several major obstacles to healthcare reform. From encouraging episodic care rather than holistic and well-care management to preventing provider collaboration through inefficiencies in use of electronic health records (EHRs), these silo-based barriers slow our progress to achieving the cost and quality goals of the Triple Aim. By taking a closer look at each of these problems, we begin to see a path toward a better future.
1. Episodic vs. Holistic Healthcare: Episodic approaches to care delivery interfere with overall care by ignoring the totality of an individual’s health leading to duplication of services and increased costs. Reimagining the healthcare system to focus on holistic approaches requires a more open exchange of information and shared accountability. Shifting to a holistic healthcare system will break down the operational silos that are inherent to episodic care and support higher quality collaborative care.
2. Moving from Episodic-Care to Well-Care Management: As we move from episodic to well-care management, increased access to services must be provided. Healthcare silos do not work collectively to offer continuous and comprehensive services across the healthcare continuum. In response, the development of wide-ranging interventions targeted not only at high risk but also at moderate and low risk individuals is imperative. Lower intensity preventative care interventions enable better well-care management that not only slow the progression of increasing acuity but also facilitate better care as individuals progress along the continuum and require acute, chronic and end-of-life care.
3. Removing the Barriers to Collaborative Care: Communication between individuals, providers, hospitals, acute care facilities and home-healthcare agencies must be well established and easily accessible. Healthcare silos prevent information exchange and limit sharing of quality data, which constricts efforts to improve care. Optimizing the usage of EHRs and establishing health information exchanges are necessary steps to removing barriers and supporting collaborative care. Healthcare technology is integral to improve collaboration and is critical in breaking down the barriers of a silo-based system.
The Triple Aim Movement
As we embrace a new era in healthcare reform, we will see an even greater emphasis on new care delivery and payment models to meet the objectives of the Triple Aim. The movement toward higher quality care standards and decreased cost is dependent on a shift to holistic care. Successful holistic care models will focus on prevention and high levels of collaboration that exploit advanced technologies. Breaking down the silo-based healthcare system requires continuous evaluation and correction of the behaviors that perpetuate them and undercut the objectives of the Triple Aim.