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Context: In 2008, researchers at the Institute for Healthcare Improvement (IHI) described the Triple Aim as simultaneously \"improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.\" IHI and its close colleagues had determined that both individual and societal changes were needed. Methods: In 2007, IHI began recruiting organizations from around the world to participate in a collaborative to implement what became known as the Triple Aim. The 141 participating organizations included health care systems, hospitals, health care insurance companies, and others closely tied to health care. In addition, key groups outside the health care system were represented, such as public health agencies, social services groups, and community coalitions. This collaborative provided a structure for observational research. By noting the contrasts between the contexts and structures of those sites in the collaborative that progressed and those that did not, we were able to develop an ex post theory of what is needed for an organization or community to successfully pursue the Triple Aim. Findings: Drawing on our 7 years of experience, we describe the 3 major principles that guided the organizations and communities working on the Triple Aim: creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time. Conclusions: The concept of the Triple Aim is now widely used, because of IHI's work with many organizations and also because of the adoption of the Triple Aim as part of the national strategy for US health care, developed during the implementation of the Patient Protection and Affordable Care Act of 2010. Even those organizations working on the Triple Aim before IHI coined the term found our concept to be useful because it helped them think about all 3 dimensions at once and organize their work around them.

Since the passage of the Affordable Care Act, there has been much speculation about how many employers will stop offering health insurance once the act's major coverage provisions take effect. Some observers predict little aggregate effect, but others believe that 2014 will mark the beginning of the end for our current system of employer- sponsored insurance. We use theoretical and empirical evidence to address the question, \"How will employers' offerings of health insurance change under health reform?\" First, we describe the economic reasons why employers offer insurance. Second, we recap the relevant provisions of health reform and use our economic framework to consider how they may affect employers' offerings. Third, we review the various predictions that have been made about those offerings under health reform. Finally, we offer some observations on interpreting early data from 2014. [PUBLICATION ABSTRACT]

The excise tax on high-cost health insurance plans (known as the Cadillac tax) under the Affordable Care Act (ACA) is an important part of the law's attempt to control rising health care costs. Analysts using different data sources have come to divergent estimates of how many people would be affected by this tax. We used the National Compensation survey from the Bureau of Labor statistics, which is better suited to this analysis because of its law-relevant details on employer-provided health benefits. Our research clarifies an important area of empirical uncertainty, thereby informing the debate about the ACA and its proposed replacements. Our base estimate of impact, 12 percent of workers participating in employer-provided health plans in 2020, lies in the middle of other estimates, but it is considerably more comprehensive, accurate, and delineated by worker characteristics (region, number of employees at the firm, industry, occupation, and so on) than others. Workers affected at the highest rate include those in education occupations and high-income workers, while those in industries involving manual labor and public safety are affected at some of the lowest rates.

Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers' incentives to offer health insurance and workers' incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong.

The author reviews the history of employer-sponsored health insurance in the United States and outlines how it became the cornerstone of the nation's health care system. He discusses the implications of employer-based insurance for access to and the affordability and quality of health care. The author outlines how employer-sponsored health insurance became the cornerstone of the nation's health care system. He discusses the implications of employer-based insurance for access to health care and its affordability and quality. Varied as they may be, most U.S. readers of the Journal probably share at least one thing: employer-sponsored health insurance is vital to their well-being. For their part, most physicians, regardless of their field of medicine or where they practice, depend heavily on employer-sponsored insurance for their paychecks. Since increasing numbers of physicians today are employees of health care organizations, many acquire their own and their family's health insurance in their workplace. 1 In this regard, they have much in common with their patients. More than 159 million Americans — 62.4 percent of the nonelderly population — had health care coverage . . .

Redesigning Employee Health Incentives Starting in 2014, employers will be able to use a portion of employees' health insurance premiums to provide outcome-based wellness incentives to try to cut health care costs. But evidence that such programs work is scant. Lessons from behavioral economics might help. Buried as Section 2705 of the Patient Protection and Affordable Care Act (ACA) is a provision of potentially momentous importance. Beginning in 2014, employers may use up to 30% of the total amount of employees' health insurance premiums (50% at the discretion of the secretary of health and human services) to provide outcome-based wellness incentives. Such rewards can “be in the form of a discount or rebate of a premium or contribution, a waiver of all or part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or the value of a benefit that . . .

Our annual Employer Health Benefits Survey contains findings from interviews with 1,927 public and private employers surveyed during the first five months of 2008. Average annual premiums in 2008 are$4,704 for single coverage and $ 12,680 for family coverage. These amounts are about 5 percent higher than premiums were last year. Enrollment in high-deductible health plans with a savings option increased to 8 percent of covered workers, up from 5 percent in 2007. Deductibles in preferred provider organizations, the plan type with the largest enrollment, increased from 2007 levels. This paper also provides new insights into firms' offering wellness programs and retiree health benefits. [PUBLICATION ABSTRACT]

Our annual analysis of health benefits contains findings from interviews of 2,046 public and private employers surveyed during January-May 2010. Average annual premiums in 2010 were$5,049 for single coverage and $ 13,770 for family coverage-up 5 percent and 3 percent from 2009, respectively. Workers paid more toward premiums in 2010, and more workers are in consumer-directed plans and plans with high deductibles than in 2009. Thirty percent of firms reported that they reduced the scope of benefits or increased cost sharing because of the recession. Surprisingly, the percentage of firms offering health benefits in 2010 increased to 69 percent, up from 60 percent in 2009. The change was largely driven by a thirteen-percentage-point increase in the number of firms with three to nine workers that offered benefits (up from 46 percent in 2009 to 59 percent in 2010). The reason for this increase is unclear. [PUBLICATION ABSTRACT]

In 2008 San Francisco implemented a pay-or-play employer mandate that required firms operating in the city to provide health insurance coverage for employees or contribute to the city's \"public option\" health access program, Healthy San Francisco. Using data from our Bay Area Employer Health Benefits Survey, we found that in the first two years after implementation, more employers offered insurance and provided employee health benefit coverage relative to employers outside San Francisco not subject to the mandate. Sixty-seven percent reported in 2009 that they had expanded benefits since 2007. Although 22 percent of firms responding to the survey reported contributing to Healthy San Francisco for some employees, we observed no crowd-out of private insurance. Premium changes between 2007 and 2009 were similar in San Francisco and surrounding areas, but more of the burden of premium contributions in San Francisco shifted from workers to employers. Overall, 64 percent of firms responding to the survey supported the employer mandate. San Francisco's experience indicates that such a mandate is feasible, increases access, and is acceptable to many employers, which bodes well for the national employer mandate that will take effect under the Affordable Care Act in 2014. [PUBLICATION ABSTRACT]

Health financing and entitlement systems linked to employment can disadvantage women, argue Lavanya Vijayasingham and colleagues