title: The Triple Aim and its implications on the management of chronic rhinosinusitis.
abstract: BACKGROUND
  Accountable care organizations (ACO) and alternative payment models are a sign of the change in reimbursement from fee-for-service to value-based reimbursement. The focus of health care under ACOs is represented by the Triple Aim: to improve the experience of health care, improve the health of populations, and reduce the per capita costs. Individuals with chronic rhinosinusitis (CRS) are heavy consumers of health care services. Results of recent studies have indicated that there is the potential for improved outcomes and cost savings from early surgical intervention. Adhering to the principles of the Triple Aim may signal a paradigm shift in regard to timing of intervention for CRS in certain patients.
  
  
  METHODS
  A scoping review was performed to analyze the current literature related to management of CRS and the impact on cost, population health outcomes, and the patient's experience of health care.
  
  
  RESULTS
  A growing body of literature indicates that, in appropriately selected patients, when compared with medical management, endoscopic sinus surgery has the potential to improve patient outcomes and reduce the long-term cost burden of CRS.
  
  
  CONCLUSIONS
  With the advent of ACOs, a paradigm shift in the treatment of CRS is inevitable to better conform to the goals of the Triple Aim. Future treatment algorithms will need to account for the heterogeneity within CRS and seek to identify appropriate timing and interventions for patients on an individual basis if the value of health care is to be improved.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA.
authors.forename: Jonnae Y
authors.initials: JY
authors.lastname: Barry
authors.forename: Hilary C
authors.initials: HC
authors.lastname: McCrary
authors.forename: Sean
authors.initials: S
authors.lastname: Kent
authors.forename: Ahlam A
authors.initials: AA
authors.lastname: Saleh
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Chang
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
mesh_terms: D060866:Accountable Care Organizations; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D019468:Disease Management; D004724:Endoscopy; D006801:Humans; D010256:Paranasal Sinuses / Q000601:surgery*; D058996:Quality Improvement; D012220:Rhinitis / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D012852:Sinusitis / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D014481:United States / Q000453:epidemiology