In 2008, Berwick et al. articulated the Triple Aim — improved care experience, improved population health, and reduced costs. Eight years later, the Triple Aim has become the health care sector’s dominant framework and has led to notable improvements: the cost curve is bending and the safety of care is better. Yet, the basic paradigm — which focuses on traditional health care delivery, rather than health itself — has not shifted. It is as if three aims are too many for the sector to tackle at once. While much energy has been invested in improving the care experience and reducing costs, the final aim of improving population health remains elusive — a Ghost Aim.

So it comes as no surprise that the United States still ranks last among 11 industrialized countries on health system quality, efficiency, access to care, equity, and healthy lives. After all, only 10% of health outcomes are affected by medical care, whereas 60% are rooted in social and environmental factors and associated behaviors — which are the essence of population health. To frontline clinicians who grasp the big picture of their patients’ lives, this is hardly news. For example, over half of frequently hospitalized patients lack access to healthy food or are at risk of not having enough food. ….more