What is it, and how can technology help achieve it?

How does the quintuple target compare with the quadruple target?

Quadruple aim and quintuple aim expand on the goals stated in triple aim. In 2014, the goal of improving the work life of healthcare providers was added to the Quadruple Aim. Shortage of physicians and lack of staff has been a concern in healthcare for years. The authors of the new objective argued that positive participation of the health care workforce “is of paramount importance in achieving the primary goal of the Triple Aim – improving population health.”

The pandemic compounded the problem, with many healthcare workers leaving the industry due to burnout as COVID-19 took a toll on the industry, making the quintuple target as important in 2020 as it was in 2014.

However, another long-standing need was highlighted during the pandemic: health equity. In January 2022, a group of healthcare leaders – Dr. Kedar Mate, CEO and President of IHI; Dr. Lisa Cooper, Professor of Medicine at the Johns Hopkins University School of Medicine and Founder and Director of the Johns Hopkins Center for Health Equity; And Dr. Shantanu Nandi, Chief Medical Officer, Accolade, proposed a quintuple objective.

Read more: Learn how modern data platforms advance the quintuple goal.

Nandy points out that health care organizations began to realize that improving health and reducing costs at the expense of physicians’ well-being hindered overall progress.

“If you want to drive sustained improvement in health care, you also have to be able to address burnout,” he says.

While disparity has been a long-standing issue in healthcare, Nandy says it has been exacerbated by the pandemic.

“In the early days, many people saw COVID-19 as the ‘great equalizer’, and then we realized very quickly that this is not true at all,” he says, “both in terms of who got COVID-19 and who suffered serious harm and death. Also, with all the things happening socially within our country, it’s really created an opportunity to take what’s been here for decades and bring it to the forefront of healthcare.

In an IHI blog, Mate explained the thinking behind introducing the new objective despite initial opposition to the original Triple Aim. “At the time, some people argued that you can’t work toward all three goals at the same time without making compromises. But the defining proposition of the Triple Aim was that each goal pursued together reinforced the other. Even skeptics found over time how achieving the goals together could make progress on all of them. And it is the same with equality. Making equity an independent goal – not a byproduct of other goals – will make it clear that each objective reinforces the other.

How can technology support the Quintuple Goal in health care?

Digital health is a growing field and, supported by traditional IT, can make a huge difference in a healthcare organization’s ability to achieve the Quintuple Goal. According to Nundy, the power of digital is its ability to increase access, which is a key factor in reducing inequalities.

“We have an opportunity with health IT to create digital experiences that can reach the underserved. Now, it’s how you do it that matters,” he added. “You have to design those experiences with marginalized communities in mind first, not last or repackage. This means that when you’re building a website, you’re also building a mobile app experience, testing it with marginalized individuals in our communities and letting their feedback influence your decision-making.

He points out that making something for the average person doesn’t mean it will work for everyone. However, deliberately building things with all users in mind means it’s more likely to work for everyone.

One area gaining momentum in healthcare is data analytics. Data gives health care organizations the opportunity to learn about people’s lived experience and understand the barriers patients face.

“We don’t consistently ask people about their life experiences and social determinants of health,” Nandy says. “One way to incorporate those questions is through technology so that we can collect that data as part of a routine care visit. Doing so enables the therapist to address those topics as part of the appointment.”

Artificial intelligence also has the potential to improve outcomes of care and the workflow of physicians. Nandy says he is incredibly optimistic about the latest generation of AI, despite the lack of hype around Big Data and predictive analytics over the last 10 to 15 years.

trace: How does the AI ​​Bill of Rights affect healthcare?

“Now, we’re talking about generative AI, and I think, in a way, a lot of us have become ready to put our heads in the sand because there’s been a lot of hype cycles that haven’t impacted care in a meaningful way,” he says. “I think this time is different.”

He describes the moment when AI is currently having an opportunity to acknowledge and dismiss some of the skepticism that has developed over the years.

Nandy admits that AI has biases depending on the way it is used. For example, he points out that risk stratification models are trained on claims-based data sets, which can have significant bias because people who are marginalized are often not connected to health care. This means there will be less focus on marginalized people in the models.

However, according to Nundy, use cases such as automated texting can make a difference in health equality. A recent report from JAMA Network shows that one study’s evaluators preferred chatbot responses to physician responses in more than 78 percent of evaluations.

“They found it more empathetic, and it was still accurate,” Nandy says. “It’s the use case that presents the biggest hurdle for the marginalized right now. They can’t get appointments and when they call, people don’t answer the phone. When they ask a question, they don’t get the answers they need. I think this is an example where there is tremendous opportunity to advance health equity with these technologies.

How can healthcare leaders integrate the Quintuple Goal?

It’s easy to look at the quintuple objective and say that an organization is working towards it, but how do healthcare leaders ensure that their organization is taking practical steps to achieve the five goals?

When making decisions about an organization, Nandy stresses the importance of leaders making that decision—whether about a new technology, process or anything else—affecting all five areas of focus within the Quintuple Objective.

“It will really help narrow down your decision making,” he says.

For example, many healthcare organizations focused on increasing colon cancer screening in their community will focus on interventions such as a pop-up in the patient portal or a reminder in the electronic health record that prompts the physician to talk to the patient about scheduling a screening.

“However, if you look at it from a health equity lens, this intervention will only help people who come to the clinic and know who you are,” Nundy says. “You’re only going to help people who are already engaged in care, and you’re actually going to increase the health disparity because the gap between people who are engaged coming to the clinic and people who are not coming to the clinic is only going to widen.”

The new objective aims to get physicians and organization leaders to look at health care from a different perspective and use it to guide their decision-making.

Nandy says that to increase colon cancer screening, instead of just having a pop-up clinic, an organization should work on active outreach to the community, leverage technology for clinic outreach and improve digital onboarding and appointment scheduling on the website to drive awareness of the issue.