What the Quintuple Aim framework means for value-based care teams

Patient experience is the most important factor behind healthcare outcomes – at least according to CMS’ star quality measures. And that’s a good thing. The old fee-for-service model of healthcare often relegated patient satisfaction to the backburner. Was it considered useful? Yes. Was it the main focus? Not at all.

Today, providers that deliver personalized care are rightly rewarded for their efforts.

For value-based care teams, this is a pretty familiar concept. The happier the patient, the healthier. But there’s more to this relationship between the patient experience and the effectiveness of your care delivery. To highlight it, we’ll use the Quintuple Aim framework as a launching point.

This framework breaks down five aims – patient experience, population health success, team wellbeing, cost reduction, and health equity – as the keys to improved health outcomes. In this blog, we’ll underscore how a focus on patient experience impacts the other four aims.

1. Enhances your population health strategy

The US spends a higher percentage of its gross domestic product on healthcare than any other nation. And yet we’re dealing with a plethora of health crises, from provider shortages to care deserts.

A population health strategy aims to ease these rising costs of care delivery by helping providers target which members of their empaneled population benefit most from certain types of care.

Here’s how that process works:

  1. Identify patients most at risk of hospitalization.
  2. Engage those patients – quickly.
  3. Offer solutions that address the underlying drivers of patient health (financial insecurity, poor medication education, etc.).

Your population health strategy is only as effective as the patient data you gather, though. Fortunately, this is where a comprehensive value-based pharmacy system comes in. With it, providers can aggregate and track metrics to more narrowly target the causes of hospitalization and readmission.

Honing your population-level care protocols, in this case, is a natural extension of focusing on the patient experience. The result: more patients get life-saving care (and you incur fewer penalties that may come from readmissions).

2. Boosts care team wellbeing

Of course, population health is just one piece of the quintuple aim framework. There’s also team wellbeing. As mentioned above, we’re dealing with a rash of provider shortages. Not only that, but healthcare professionals are experiencing higher levels of burnout than ever before – and the pipeline of emerging talent is dwindling.

So how can providers and healthcare leaders promote team wellbeing? Short answer: reduce workloads. After all, the typical day for physicians often entails 10+ patient consults, medication management tasks, and ad hoc reviews of patient files ahead of future consults. It’s an unsustainable load to bear, and we’re watching the best in our field falter under it.

But the right piece of value-based care technology can help by automating and simplifying tasks for your care team. Take medication reconciliation, for example. My.RxLive compiles full medication histories for your patients. Then, it runs analytics on this EHR data to…

  • Identify the patients most likely to benefit from intervention.
  • Intervene with those patients before they experience an adverse medical event.
  • Document outcomes to support quality measures.

This helps care teams develop population-level protocols that improve health outcomes – in a fraction of the time. Plus, if you already have an existing pharmacy function managing medications or consulting with patients, RxLive helps you scale those efforts.

Within the quintuple aim framework, working at the top of a license doesn’t mean overburdening clinicians with tasks they could do. It’s about focusing their efforts on tasks they’re uniquely qualified to perform.

3. Reduces costs across the board

Cost reduction is another key piece of the quintuple aim framework – and it’s particularly important today. We’re living in a time where healthcare costs are simultaneously…

  1. Driving patients to seek cheaper forms of care (or avoid it outright) AND
  2. Not high enough to offset the margin pressure that health system leaders are experiencing.

Still, with HEDIS measures weighing (the avoidance of) hospitalization and readmission so highly, there’s an opportunity to optimize costs by also improving the patient experience. And the right technology can enhance the efforts you take.

We know that fewer hospitalizations lower costs – for both the provider and the patient. Investing in technology that targets which patients in your population are most at risk for hospitalization directly contributes to this cost-cutting effort.

Similarly, rising drug costs are driving patients to modify prescriptions or simply avoid refilling them. The same tech you use to assess patient health risk is the same tech your pharmacy function can use to perform medication reconciliation and:

  • Eliminate unnecessary polypharmacy. (Think: opioid prescriptions for conditions that otherwise may be treated with non-opioid analgesics.)
  • Identify cheaper alternatives to brand-name prescriptions. One example: for patients with wet macular degeneration, switching to the biosimilar Byooviz from Lucentis could save more than $10,000 per year.
  • Seek out financial assistance programs for at-risk patients. Organizations like NeedyMeds and RxAssist list patient assistance programs (PAPs) in searchable databases. Pharmacists can also identify other cost-cutting measures, like prescription discount cards.

Your patients get the care they need at prices they can afford. You deliver that care while streamlining costs. You improve the patient experience as a result.

Patient experience is your North Star

The patient experience will factor heavily into providers’ quality scores until at least 2026 – CMS has proposed a rule that will lessen its impact to a degree.

But that’s the unknown. What we know is this: a focus on patient experience helps improve the other aspects of your care delivery, from the execution of your population-level health outcomes to the wellbeing of your care team.

As Dr. Marianne Ivey highlighted in a recent interview with us, healthcare is a people business at the end of the day. When you prioritize the patient, good things follow.

Interested in learning how a comprehensive, value-based pharmacy solution can help improve your patient experience and boost your bottom line? Reach out!

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.