Why It Matters
George Kerwin, Bellin Health's President and CEO, explains how his organization began its population health transformation by starting small.
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Dear IHI: Can You Pursue the Triple Aim by Starting Small?

By Jo Ann Endo | Thursday, October 20, 2016
Dear IHI - Can You Pursue the Triple Aim by Starting Small?


I'm heading up a new population management team at my health system. What advice do you have for an organization that doesn't have a surplus of resources, but recognizes that we have to adapt if we're going to achieve the Triple Aim? We're not Bellin or Kaiser Permanente or Cincinnati Children's!




The good news is you are on the right path. Your organization has recognized that population health is an area that requires focus.

Our organization was also midsized in the Midwest when we began our population health efforts. We are a regional health system based in Green Bay, Wisconsin, with a metro-area population of about 300,000. You may have heard of us — but I’ll save that until the end.

In the simplest of terms, population health is about taking the information you know about a group of people — anything that makes them unique and could impact their health — and creating a plan to solve challenges and fuel positive change.

By developing the Triple Aim, IHI has developed a platform we can use to measure our success. It’s not so much about achieving the Triple Aim (as you said), as it is about simultaneously moving the needle in the right direction on those three meters, with one never coming at the expense of another.

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Like you, we faced the daunting task of making big changes, so we started small. In fact, we didn’t go outside of our organization. We began with our employees. We had fewer than 3,000 at the time.

Our motivations matched the Triple Aim. We wanted to control costs (reduce our health coverage spending, reduce absenteeism, and increase productivity), improve quality (fewer preventable and chronic health claims, healthier employees), and generate a positive patient experience (greater employee satisfaction and improved retention).

To develop the data and measurement system we needed, we implemented voluntary health risk appraisals (HRAs) for employees. A few years later, we added HRAs for spouses. Today, they are mandatory to be eligible for the top tier of our medical plan.

We coupled HRAs with employee engagement techniques:

  • Two full-time nurses who serve as health coaches
  • Free annual physicals/screenings
  • 24/7 nurse on-call line to answer health questions
  • Appropriate referrals and same-day appointments
  • Free visits to our retail health clinics for employees and those covered by their insurance

As you read this, you might feel like reminding me about your resource constraints. We have those, too, but our investments have paid dividends in the health of our employee population. In the last decade, HRA scores rose from an average of 70.5 points to 81.2 points out of 100. While most other organizations have struggled with cost increases for providing medical coverage, we’ve saved more than $26 million. We’ve drastically reduced our annual large claims for major health issues such as breast cancers and musculoskeletal issues. Employee satisfaction and retention scores continue to be among the best in our market.

We realized we could take what we were learning and implementing within our organization and help other employers — other populations — manage their health. Soon, we were helping banks, manufacturers, school districts, city and county governments, and a host of other employers.

In 2012, we applied this same approach to managing cost, quality, and satisfaction when we entered CMS’s Pioneer Accountable Care Organization program. And while a program of that magnitude may seem like a destination you won’t reach in the near future, we got there the same way you will — one step at a time.

Choose a population. Take responsibility for improving its health. Then lead change. You’ll make a fellow Midwest health care provider proud.

Good luck,


George Kerwin

President and Chief Executive Officer
Bellin Health


George Kerwin is faculty for IHI’s Leading Population Health Transformation seminar.

Editor's Note: "Dear IHI" is an advice column in which IHI experts answer questions from health care change agents in the field. Leave your advice in the comments. Have a question for "Dear IHI"? Send it to info@ihi.org or on Twitter using the hashtag #DearIHI and @TheIHI.

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