Understanding Healthcare’s New Quintuple Aim

The Quintuple Aim requires a dedicated practice to evaluate marginalized populations when considering how healthcare is delivered.

American healthcare has been marked by an evolution of marketplace trends that have impacted hospital leaderships in how they operate and achieve success. To adjust to the business of healthcare, hospitals have had to add unique positions to accommodate new considerations for how we define “value” to the patients and communities we serve. 

In the 80s and 90s, we saw the rise of managed care, which fueled the healthcare race for market share. Hospitals were gobbled up into major networks to create muscle with the payers and leverage better contracts and increased customer base. 

In the mid- to late 2000s, the Triple Aim became a major factor in the value equation for the Patient Protection and Affordable Care Act (PPACA) – and it is still the guide for the Institute for Health Improvement (IHI). The three prongs – improving patient experience, improving the health of our population, and reducing the cost of healthcare – are outlined as key methods to achieve value-based care. 

In 2014, we saw a new prong, making the Quadruple Aim. The fourth component suggested that without acknowledging physician and healthcare employee satisfaction, the Triple Aim was unachievable. This point still holds true today, as we see how burnout and occupational trauma of our healthcare workforce can easily lead to medical errors (and not the best customer experience). It is hard to give when you have nothing left in the tank. The significance of this aim was not that we need another component, but that the marketplace must consider its providers when determining the value of healthcare provided. 

Today, the new ask is for the Quintuple Aim, made particularly relevant over the last two years, as we must no longer ignore health disparities. The argument is once again that without the requirement for health equity, we will not achieve our value proposition of the right care, at the right place, at the right cost.

The Quintuple Aim requires a dedicated practice to evaluate marginalized populations in your community when considering how healthcare is delivered. This includes considerations for race, rural communities, age, individuals with disabilities, and poverty, to name a few.

The latest LAN report highlighted how great payers and health systems are at tracking data regarding social determinants of health (SDoH) and health disparities. But organizations and payers have not really determined clear guidelines or recommendations for how to act on the data that has been obtained. In my last reader poll, I asked about willingness to get involved to address health disparities in your community, and the most common answer was in line with the national trend: “I don’t know where to begin.” 

Some healthcare organizations and payers have started adding positions to focus attention on health disparities by adding vice presidents of health equity or managers of the SDoH. The difficulty with this question is that the answer is complex, specific to your community, and multifaceted.

Until we examine our communities for structural racism, variances in access to healthcare, housing, food, medications, education, and employment, we will struggle to achieve the real value of healthcare, which is to improve our patient’s health outcomes.

The IHI is still holding to the Triple Aim, and states that the additional concepts of employee burnout and health equity are important, but they are contributors to the success of the original North Star.

So, my question for today is, which aim do you think your healthcare organization is following? Triple, Quadruple, or Quintuple? Click here for our Monitor Monday Survey results.

Programming Note: Listen to Tiffany Ferguson’s live reports on SDoH Mondays on Monitor Mondays, 10 Eastern.