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Hal wolf, IT Innovation in integrated Care

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IT Innovation in integrated Care …

IT Innovation in integrated Care
Telehealth & telecare-congres
2 - 3 maart 2011


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  • 1. IT Innovation in Integrated Care International Congress on Telehealth and Telecare The Kings Fund, London – March 2, 2011 Hal Wolf Senior Vice President and Chief Operating Officer Kaiser Permanente, The Permanente Federation© 2011 The Permanente Federation, LLC
  • 2. Largest Integrated Health Care System in U.S.Kaiser Permanente’s mission is to provide high-quality, affordable health careservices and to improve the health of our members and the communities we serve.  Largest nonprofit health plan in USA  Largest private deployment of EHR  8.6 million members  15,000+ physicians  164,000+ employees  Serving 9 states and the District of Columbia  35 hospitals  454 medical offices  $42.1 billion annual revenuesSource: Kaiser Permanente 2009 Annual Report 2
  • 3. International Rankings andNational Health Expenditures AUS CAN GER NETH NZ UK US OVERALL RANKING (2010) * 3 6 4 1 5 2 7 Quality Care 4 7 5 2 1 3 6 Access 6.5 5 3 1 4 2 6.5 Efficiency 2 6 5 3 4 1 7 Equity 4 5 3 1 6 2 7 Long, Healthy, Productive Lives 1 2 3 4 5 6 7 HEALTH EXPENDITURES/CAPITA $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290 (2007)Note: *Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by TheCommonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey ofSicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth FundCommission on a High Performance Health System National Scorecard; and Organization for EconomicCooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009). 3
  • 4. Technology Allows a Systematic Approach Primary Secondary Acute Chronic Prevention Prevention Care Care…and accountability across the care continuum. 4
  • 5. The Physician Role Changes…  One patient at a time  Only know about patients who Traditional appear in your office Model of Care  No use of IT  Limited use of “extenders”  Accountability for panel/population New Model  Transparency  Use of EMR, registries, internet Elements  Team care (including patient)  Moving care out of Dr. office 5
  • 6. EHRs Offer Foundational Data DATA INFORMATIONAMOUNT GAP KNOWLEDGE GAP GAP CLINICAL UTILITY TIME Source: Michael N. Liebman, PhD Executive Director Windber Research Institute 6
  • 7. Technology Enables Clinical IntegrationEHRs move vertically integrated care towardimproved clinically integrated care  Disease Registries  Improved Pathways of Care  Improved Demand Management  Targeted Patient Goals Toward Prevention  Population Care Management Tools 7
  • 8. Results are Improved Quality & OutcomesExample:Healthy Bones – Identification, Screening,Treatment for Osteoporosis  Program includes men and women 50+ with a fracture and women 65+/men 70+ with poor dual energy x-ray absorptiometry (DEXA) scan results  47% fewer fractures in 2009 that expected  Fractures reduced from 3.2 per 1,000 in 1999 to 2.5 per 1,000 in 2010  Since 2006 4,000 reduced fractures than expected and an estimated 1,000 lives saved  Required data to identify and stratify members at risk; Care Manager to provide “just in time” osteoporosis evaluation; access to diagnostic technology; outreach/in-reach system; performance reporting 8
  • 9. Patient Expectations Have ChangedSource: http://thisisindexed.com/2007/06/not-surprisingly-they-always-have-money-and-forbes-in-the-waiting-room/ 9
  • 10. Extending Our Community Clinical Utility Clinical Utility Prevention Physician-Patient Web-Based Health Social Networking one-to-one Assessment many-to-many one-to-many 10
  • 11. Personal Health Record – My Health ManagerWe’re Online Because Our Members Are Online English and Spanish content 2010 Cumulative Metrics  3.3 million registered users  86 million total visits  10.7 million secure emails sent to doctors  2.3 million appointments scheduled online  8.3 million prescriptions refilled online  25.8 million lab test results viewed online 11
  • 12. 58% of Kaiser Permanente Members areEngaged in their Health Online 58% 48% 50% 29% 22% 2006 2007 2008 2009 2010 Estimated members with access to secure features as a percent of total eligible Kaiser Permanente membership (over age 13 with regular internet access). 12
  • 13. Top Doctors + Social Media: Success 4,537 clickshttp://bit.ly/kpsunsafety 13
  • 14. Leveraging Social MediaTwitter  @kpnewscenter (Dec. 2009): 3,832 followers, 1,221 tweets  @kphistory (summer 2009): 152 followers, 199 tweets  @kpthrive (summer 2009): 610 followers, 535 tweets  @kpvivabien (summer 2009): 66 followers, 201 tweetsFacebook (launched summer 2008)  Kaiser Permanente Thrive: 9,465 “fans”  205 Wall posts (e.g., articles/links we posted for our fans)  128,000 page viewsYouTube (launched summer 2008)  Total videos: 156  Total views: 350,680  Most popular: "When I Grow Up" 133,628 views 14
  • 15. Supporting Patient Expectations: Telehealth Ability to provide care regardless of time or location Connecting patients to a system before they get sick Improving C02 emissions Helping people age in place • The majority of American will age at home and not in facilities Leveraging clinical integration • Specialty availability across distances • Geographic expansion of primary care 15
  • 16. Telehealth “When I use a word…it means just what I choose it to mean – neither more nor less.” - Humpty Dumpty to Alice Lewis Carol (Through the Looking Glass) Telemedicine Telecare Teleconsultation Televisit Telemonitoring / home monitoring / remote patient monitoring Mobile health or m-health Virtual care 16
  • 17. Three Models Real-time Teleconsultation Store-and-forward Teleconsultation Telemonitoring (Remote Patient Monitoring) © 2011 Kaiser Permanente Proprietary & confidential 17
  • 18. Real-Time Teleconsultation Modality Pros Cons Comments Real-time Immediacy Must schedule all Addresses Teleconsultation ‘In person’ parties at once inequitable Trust Not more efficient distribution, not Consultant able to Supply ≠ demand scarcity drive session Scope expansion Avoids travel Teaching moment Regulatory implications © 2011 Kaiser Permanente Proprietary & confidential 18
  • 19. Store-and-Forward Teleconsultation Modality Pros Cons Comments Store-and-forward More efficient Time lag to Addresses Teleconsultation Defined scope diagnosis inequitable Supply = demand Limited patient distribution and All parties work interaction scarcity independently Potential distrust Avoids travel © 2011 Kaiser Permanente Proprietary & confidential 19
  • 20. Store-and-Forward Teleconsultation Example:Teledermatology at KP Northern California  Patient given 2 options: 1. Rapid response - wait for Telederm with specialist 2. Deferred - at a later date PCP schedules in-person consult with specialist  All medical centers offer either Telederm or roving derm (dermatologist goes to PCPs office to see patient)  45,000 virtual consults since 2008 (3,000/month, 136/day)Photo: Telederm Application 20
  • 21. Remote Patient Monitoring Modality Pros Cons Comments Telemonitoring Better access Data issues Multimodal by ‘Personalization’ Integration issues population Early detection Rules engine issues Team-based care Fewer visits and Requires initial in- hospitalizations person visit Members love it © 2011 Kaiser Permanente Proprietary & confidential 21
  • 22. Biomedical Systems: Background 22
  • 23. Thank you Hal WolfSenior Vice President and Chief Operating Officer Kaiser Permanente, The Permanente Federation hal.wolf@kp.org 23