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+ reduce, or at least control, the per capita cost of care Improving the U.S. health care system requires the simultaneous pursuit of these three aims. Additionally, there are preconditions that must be met, including the enrollment of an identified population in a "triple aim" program, a commitment to universality for its members and the existence of an organi- zation — an integrator — that accepts an administrative responsibility for all three aims for a defined population. Achieving the net effect of a successful "triple aim" program at a local, state or national level within the existing framework of our health care system has become more of a political challenge and less of a technical one. The recent media frenzy and polarized public opinion surrounding the ACA Supreme Court hearings serves as evidence. The painful pill we must swallow to achieve a suc- cessful result must involve a disruption of well-established institutions, health insurance industry dogma, reimburse- ment appropriations and pre-existing health policy ideology. The state of Texas embarked on such a "triple aim" experiment with the submission of an application to the CMS for a Medicaid Demonstration Waiver, which was approved in December 2011. The decision to apply for economic relief was a direct result of a statewide hospital funding crisis, which required a solution to spiraling Medicaid costs for uncompensated care for state rural and urban hospitals. The waiver presents an opportunity to access some $30 billion over its five-year life by present- ing two sources for funding. One is for uncompensated care, and the other is for delivery system reform incentive payments (DSRIP). Each DSRIP must meet the criteria set forth in the "triple aim" postulate, improve the quality of health care, improve access to providers and reduce costs. This, then, is the tipping point for "triple aim" health care dynamics and beta testing in Texas. It is already in full motion, having both short- and MDNEWS.COM s MD NEWS San Antonio | 17 long-term effects on how Texans will pay for and access care across a continuum of rural and urban health resources. The organizational dynamics are in place for health care reform. The question is whether the political infrastructure, both local and state, will endorse and implement this change or serve as a deterrent and bring about its eventual and unavoidable demise. More than 20 years of marketing and advertising experience, along with graduate degrees in business and health care administration, make Pat Riley, M.B.A., M.H.A., CHE, COO of KGBTexas Healthcare Solutions, a strategic resource for KGBTexas clients wanting to increase revenues, maximize advertising leverage and demonstrate a healthy return on investment. He has professional advertising agency experience and has held senior marketing positions for health systems, hospitals and managed care firms. He can be reached at (210) 826-8899. s