Leland et.al. (2015) state that "Failure of the profession to clearly demarcate what constitutes high-quality occupational therapy and demonstrate its contribution to the broader patient outcomes that value-based care will measure may marginalize occupational therapy in the rapidly changing health care environment."
Unfortunately, the authors align the concept of 'value' with the IHI 'Triple Aim' that includes "improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations." (Berwick, Nolan, and Whittington, 2008). These objectives sound quite noble, but they break the primary social contract that health care providers have with their patients - namely to provide competent and ethical care that is based on needs and that promotes health.
The 'Triple Aim' is a politically oriented initiative that seeks to control the costs of health care as it is being taken over by governmental structures. It has very little to do with actual care. Gur-Arie (2013) summarized the proper concern that people should have about 'Triple Aim' best:
When you find yourself in a strange room, partially covered by a large paper towel, and otherwise completely naked, contemplating the upcoming prodding of your most private body parts by shiny instruments and strange hands, what do you want to know most about the person about to enter the room? Would you feel better knowing that the stranger turning the knob on that door has an iPhone compatible website for you to peruse from the comfort of your cubicle at work? Would you feel safer knowing that he or she has financial responsibilities and commitments to a faceless corporate office for which your naked body is just a line item on the balance sheet, perhaps a socially responsible balance sheet, but a balance sheet nevertheless? If it’s your small child under that paper towel, would you be comforted knowing that this person’s prime directive is to minimize your child’s “per capita” cost (not price) of care? And when you’re done making imaginary deals with your God or the devil, would you experience great relief knowing that the doctor walking into the room now is not really “your” doctor, but the shepherd of “populations” and the averter of deficits and fiscal cliffs?
The IHI and its founders who champion the 'Triple Aim' are interested in nothing short of the complete socialization of the American Health Care system into a model like the British NHS. The founder of the IHI has rather infamously stated, "Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional." For those who want to hear it with their own ears:
Occupational therapists who oppose the unabashed politicization of the profession need to stand up and tell the leaders of the American Occupational Therapy Association that enough is enough.
The professional association needs to return to a focus on supporting occupational therapists, promoting the profession, and setting apolitical standards that promote the highest quality of care.
Occupational therapists need to put an immediate end to the use of the professional association as a lever arm in some partisan agenda that is in absolute contradiction to our historic values and beliefs.
Berwick, D. M., Nolan, T. W., and Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27, 759–769. http://dx.doi.org/10.1377/hlthaff.27.3.759
Gur-Arie, M. (2013 February 9). How pushing the Triple Aim ignores doctors and their patients. KevinMD.com Medical Weblog. Available from http://www.kevinmd.com/blog/2013/02/pushing-triple-aim-ignores-doctors-patients.html
Leland, N.E.; Crum, K.; Phipps, S.; Roberts, P. and Gage, B. (2014). Advancing the value and quality of occupational therapy in health service delivery. American Journal of Occupational Therapy, 69, 6901090010p1-6901090010p7. doi: 10.5014/ajot.2015.691001.