Manchester Triple Aim

Dates: 2011-2013

State: New Hampshire

Client(s): Dartmouth College

Services: Health Care & Public Health Planning, Training & Technical Assistance, Health Systems Transformation

Technical Expertise: Health Care Reform, Health Disparities, Safety Net, State and Local Public Health


Often referred to as the “triple aim,” health care improvement requires a focus on three critical objectives: Improving the health of the population, enhancing the patient experience, and reducing the cost of care. Seeking to address the “triple aim” on a local level in the City of Manchester, New Hampshire, The Dartmouth Institute and the City of Manchester Health Department asked JSI to coordinate triple aim efforts in the City.

Health care is a complex system that operates at many different levels. JSI recognized that a multi-pronged approach was essential to making change in such a complex system and undertook three different approaches to advancing the triple aim goals.

First, JSI coordinated the Manchester Sustainable Access Project, a leadership team of local hospital, community health center, and outpatient care center medical directors, as well as the Manchester Health Department and local mental health center. The team of health care leaders convened on a monthly basis to strategize and collaborate on approaches to ensuring access to care for Medicaid and uninsured residents in the Manchester health service area.

JSI also partnered with the ReThink Health Dynamics project of the Rippel Foundation to build a simulation model that allows leaders and strategic planners in Manchester to simulate how various interventions will influence health outcomes, spending, and savings through 2040. The simulation, allows users to explore the results of combined interventions versus single interventions, as well as adjust the funding amount and mechanism. Users can simulate the sustainability of an intervention when savings are captured and reinvested, as well as simulate ways to combat “supply push” by sharing a percentage of savings with providers and insurers.

Finally, JSI participated in the first ReThink Health’s Organizing for Health course, a course aiming to apply the principles of organizing that have been successful in the political world to health care and public health improvement. The framework relies on establishing power WITH a community rather than asserting power over a community. This is achieved through relationship building and empowerment of co-organizers within the community. This framework will be applied to community-based projects of the Manchester Health Department, including a new active living community support research project.