The article considers if health care payers can and should incentivize providers to take responsibility for population health, even when it requires nonmedical services and the remediation of social problems, and whether the health of populations should be implicated in providers’ cost containment. The purpose of this article is to analyze the potential of the health care system to achieve the triple aim and, specifically, the attempt to improve population health by rewarding providers who contain costs. These mechanisms partake of the enduring economism of US payment policy, that is, the belief that precisely calibrated financial incentives will produce socially desirable ends. From CMS's perspective, the triple aim is vital to Medicare, and new payment mechanisms, such as the accountable care organization (ACO), have been deployed to achieve it. It is the latest and most ambitious of a succession of health care goal statements, which progressed from cost containment in the 1970s, to cost containment while/by improving quality in the 1980s and 1990s, to cost containment while/by improving quality and population health most recently. The formulation of the triple aim responds to three problems facing the US health care system: high cost, low quality, and poor health status (which frustrates efforts to contain cost and improve quality). This was possible not least through the implementation of the Affordable Care Act (ACA), specific provisions of which are considered to embody the triple aim. Berwick became administrator of the Centers for Medicare and Medicaid Services (CMS) in 2010 and described the pursuit of these three goals as the focus of his term (Fleming 2010). In 2008, Donald Berwick and colleagues proposed that the US health care system adopt the “triple aim”: to improve health care, to improve population health, and to reduce per capita health care costs (Berwick, Nolan, and Whittington 2008). Social determinants of health, payment reform, bundled payment, ACOs, integrated care Introduction It will address proposals that health care payers and providers lead in addressing the social contributors to ill health and urge payment reformers to appreciate more fully the politics and policies of other sectors and the dynamics of their inclusion in population health improvement. The conclusion section of the article will consider the politics of payment reform as social reform. These include Maryland's Global Revenue Budget model, bundled payments, and ACOs, and they highlight the extent to which this version of integration is underwritten by savings achieved by providers for the Medicare program. The second section of the article will discuss CMS's efforts to pay providers to achieve the triple aim, that is, to improve health care and population health while containing cost. The first section of the article will consider the task of improving population health through the health care system. The formulation of the triple aim responds to three problems facing the US health care system: high cost, low quality, and poor health status.
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