At ABCS RCM – Advanced Billing and Consulting Services, we are consistently reading articles and hearing news stories that discuss the rising cost of healthcare. It is true that there has been an increase in insurance deductibles and co-pays for many Americans. This debate surrounding medical expenses will only intensify as more Americans age and become eligible for Medicare benefits and require health services. However, as one examines this recent trend, it is helpful to look at the core concepts and desired outcomes in health care and how they often compete with each other. Politically, “the iron triangle” is used to describe the connections that exist between the policy-making relationship among the congressional committees, the bureaucracy, and interest groups. However, in this case, the term is applied to the field of healthcare management.
The term “the Iron Triangle of Health Care” is largely credited to William Kissisk’s book Medicine’s Dilemmas: Infinite Needs Versus Finite Resources (1994). The book presents the concept of three competing attributes in the American healthcare system: access, quality, and cost containment. Conceptually, each of these features resides at the corner of a theoretical “triangle” shape. As one moves between these features of healthcare, the consequences of each attribute change, with one increasing while the other may decrease. For example, a policy that increases access to health services would likely lower the quality of healthcare or increase the overall cost.
In the Iron Triangle paradigm, the ideal situation is one where medical professionals provide high medical access and quality, but at the lowest possible cost. The closer medical providers come to this ideal, the closer they are to delivering or producing “value” in this health care model. This has produced, or at least greatly influenced, the increasingly common term known as value-based care. This sounds straight-forward, but as any economist will tell you – there is always an opportunity cost. In the Iron Triangle of Health Care model, it is impossible to maximize all three features or characteristics. Things are made even more complex due to the fact that cost can change very quickly, while new technologies may disrupt the existing model.
In the end, people are looking for the best possible outcome. There are many political and financial “interests” in healthcare marketplace. Sometimes these interests work together and other times they directly conflict one another. ABCS RCM understands these potential conflicts and strives to provide up-to-date, relevant information to our clients. We understand that healthcare providers are going to operate successful practices, they must navigate the ever-changing landscape of the U.S. healthcare system.
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Creating Value in Health Care, Iron Triangle