Transforming Care in anIntegrated Health System         Benjamin K. Chu, MD, MPH                 President  Kaiser Permane...
Kaiser Permanente: The oldest group modelhealth maintenance organization, serving 8.6million people in 8 regions across th...
3
Kaiser Permanente SouthernCalifornia: Who We Are  3.28 Million Members  13 Hospitals  More than 120 Medical Office   Bu...
A Care Model Systems ApproachLeads to Improved Outcomes                                                                   ...
Kaiser Permanente’s IntegratedSystem Connects Health Plan andHealth Care Services                                         ...
Kaiser Permanente Is Transforming from aTraditional “Sickness Model” to Proactive CareThat Helps Prevent Debilitating Illn...
The U.S. Health Care System Overall Is TerriblyFragmented and Patient Care Is Not Coordinated                             ...
Information Systems Allow Kaiser Permanenteto Embed the “Right Thing to Do” into EachPoint of Care   Information Systems S...
Kaiser Permanente’s Care ManagementSupport Provides Better Patient ManagementUsing Evidence-Based Medicine      Patient R...
Kaiser Permanente Clinical InformationSystems Provide Better Patient ManagementUsing Evidence-Based Medicine              ...
Kaiser Permanente’s Registry for ChronicDiseases and Panel Management ProvidesInsight Across Disease Spectrums            ...
Kaiser Permanente’s Registry for ChronicDiseases and Panel Management ProvidesInsight For Each Chronic Disease      Each m...
Kaiser Permanente’s Registry for ChronicDiseases and Panel Management Can BeUsed for Physician Panel Management           ...
Kaiser Permanente Members ActivelyParticipate in Care Through kp.org  Member contacts with the health system increase thro...
Electronic Medical Records Make Tracking EasyBut Achieving Better Outcomes for PatientsRequires Using This Information to ...
Proactive Encounters Have Revolutionized    How Kaiser Permanente Provides Total Health•   Not all patients see their prim...
The Ability to Use, Not Just Store, InformationElectronically Results in Better Outcomes        Examples Include:        ...
Proactive Office Encounter:Tools for Staff and Physicians to Fill Care Gaps    Special tools and systems have been designe...
Proactive Care Gap Checklist           Gaps in the patients care are identified through the use of flags.                 ...
Outcomes: Breast Cancer ScreeningRate (ages 52–69) – #1 in the U.S.  90%  88%  86%  84%                                   ...
Outcomes: Colorectal Cancer Screening70%65%60%           27% Increase                                  National 90th55%   ...
Outcomes: Controlling High BloodPressure (ages 18-85)85%80%                 35.6% Increase                       in 4 year...
Outcomes: Osteoporosis Management 65% 60% 55% 50% 45% 40%                                              National 90th 35%  ...
Outcomes: Decreased Hip Fractures by Almost40% Due to Proactive Measures                                                 3...
Selected Hospital Outcomes in KaiserPermanente   Kaiser Permanente Southern California has made dramatic gains in         ...
Better Hospital Outcomes in KaiserPermanenteSouthern California                                                         NN...
Hospital Outcomes in Kaiser PermanenteSouthern California  Kaiser Permanente Southern California consistently performs bet...
Kaiser Permanente Has Higher CancerSurvival and Lives Saved Annually Comparedto National Data                       KP 5-y...
Kaiser Permanente Addresses the Larger Healthcare Needs of the Community Focus on primary care and  prevention, and addre...
Healthy Eating Active Living Program HelpsMake Healthy Choices Easy1.   Incorporate health into local planning     decisio...
HEAL and Operation Splash inSouthern California                             Healthy Eating, Active Living                 ...
The Amazing Food Detective:Working on better nutrition to helpstem the rise of childhood obesityProfessional theatre troup...
Farmer’s Markets at Medical CentersWorking With Local Vendors                              7 farmer’s markets at medical  ...
Kaiser Permanente Works with the Trustfor Public Land to Encourage More ActiveLifestyles    Creates open space in park-poo...
This old rail road right-of-way wasalong the southeast corridor of LosAngeles County.                                     ...
Here’s the same site and what itlooks like today thanks to the Trustfor Public Land.                                      ...
These “abuelitas” or grandmothers are working out inBelvedere Park in East Los Angeles. The Trust for PublicLand developed...
Kaiser Permanente launched anadvertising campaign – called“Thrive” – which emphasizes ahealth message for the community   ...
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Benjamin Chu: Transforming care in an integrated health system

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Benjamin Chu: Transforming care in an integrated health system

  1. 1. Transforming Care in anIntegrated Health System Benjamin K. Chu, MD, MPH President Kaiser Permanente Health Plan/Hospitals Southern California Region
  2. 2. Kaiser Permanente: The oldest group modelhealth maintenance organization, serving 8.6million people in 8 regions across the country Kaiser Permanente Kaiser Permanente’s capitated payment model Programwide places as much emphasis on keeping people health • 8.6 Million Members as it does on caring for members when they are ill. • 32 Hospitals • 420 Medical Office Buildings • 14,000 Physicians • 156,853 Employees • $40 Billion Annual Revenue • 600 – 700 Residents and Fellows • $4 Billion Health Information Technology Investment • 60 Years of Providing Care • Focus on prevention of illness and disease 2
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  4. 4. Kaiser Permanente SouthernCalifornia: Who We Are  3.28 Million Members  13 Hospitals  More than 120 Medical Office Buildings  55,000 Employees  6,500 Physicians  280,000 Hospital Discharges  34,400 Babies Delivered Annually  17.7 Million Outpatient Visits  22.7 Million Prescriptions Filled  305,800 Annual Home Health Visits  $14 Billion Annual Revenue  Full implementation of electronic medical record in all hospitals and medical office buildings 4
  5. 5. A Care Model Systems ApproachLeads to Improved Outcomes Community Health System Resources Health Care Organization Information and Policies Systems Self- Support Management Delivery Decision Support System Support Tools Design Informed, Productive Prepared, Interactions Proactive Activated Patient Practice Team Improved Outcomes  Source: Adapted from the Chronic Care Model,  Ed Wagner, MD, www.improvingchroniccare.org 5
  6. 6. Kaiser Permanente’s IntegratedSystem Connects Health Plan andHealth Care Services • Kaiser Permanente has integrated finance and care HEALTH PLAN delivery services MEMBERS • This creates the ability to allocate resources where needed to achieve the best health outcomes for the patient • Kaiser Permanente’s capitated payment model places as KAISER much emphasis on keeping FOUNDATION people health as it does on HEALTH PLAN caring for members when they are ill. KAISER Southern California FOUNDATION PERMANENTE HOSPITALS MEDICAL GROUP 6
  7. 7. Kaiser Permanente Is Transforming from aTraditional “Sickness Model” to Proactive CareThat Helps Prevent Debilitating Illness What is required is a new patient-centric care model, which is characterized by:  Proactive Care Processes  Care Delivered by a Health Care Team  Care Integrated across Time, Place, and Conditions  Care Delivered through Group Appointments, Nurse Clinics, Telephone, Internet, E-mail, Remote Care Technology  Self-Management Support that Is Integral to the Delivery System In today’s complex health care world, in which chronic illness is a larger burden than ever before, a single physician cannot fulfill all the functions necessary to optimize health outcomes for patients in a series of short interactions. 7
  8. 8. The U.S. Health Care System Overall Is TerriblyFragmented and Patient Care Is Not Coordinated Call Center Primary Care Advice Center Office Skilled Nursing Laboratory Facility Specialty Care Office Hospital Home (Self-Care) Health Plans Urgent Care Pharmacy Emergency Dept. Media/Web DME Rehabilitation Hospice Radiology 8
  9. 9. Information Systems Allow Kaiser Permanenteto Embed the “Right Thing to Do” into EachPoint of Care Information Systems Support Care Across the Integrated Continuum of Care and Contribute to a Better Understanding of Each Patient’s Health Needs Primary Care • Reminder/Prompts Call Center/ Hospital • Treatment Protocols • 24/7 availability of clinical Advice Nurse • Standing Orders information • Scripts • Patient Safety • Access to Registry • Protocols Imperative • Decision support tools • Highly Reliable Care Specialty Care • Reminder/Prompts Emergency Room • 24/7 availability of clinical • Standing Orders information • Protocols • Access to Registry Member- • Decision support tools Centered Care Urgent Care • Reminders/Prompts Rehabilitation Management Facility Care/Case Management • Protocols Skilled Nursing Facility Health Home Pharmacy • Protocols Education • Outreach Letters • Alerts • Telephone Outreach Laboratory • Counseling • Flu Shot Reminders • Automated • Healthphone Standing • Healthwise Handbook Orders • Member Web site • Remote Monitoring 9Adapted from: Hyatt JD, Benton RP, Derose SF, JCOM, April 2002
  10. 10. Kaiser Permanente’s Care ManagementSupport Provides Better Patient ManagementUsing Evidence-Based Medicine  Patient Registry and Concurrent Tracking System • Identifies all members in the population • Risk stratifies population for targeting interventions and resources • Tracks and monitors each patient for key indicators (lab, pharmacy, encounters, clinical indicators, etc.) • Easy Access (Web-based)  Care Management Systems • Flags/Alerts • Supports Telephone management and documentation  Supports Automated Clinical Decision Support and Practice Tools • In-reach/Outreach  Health Education and Self-Care Support 10
  11. 11. Kaiser Permanente Clinical InformationSystems Provide Better Patient ManagementUsing Evidence-Based Medicine Registries Labs Risk stratification of population Hospital Identify subgroups Pharmacy needing specific care Patient management Outpatient tools Appointments Clinical Targeted panel lists Information Prompts, reminders for Outpatient Encounter Systems clinicians Letters and automated Membership telephone outreach to members Emergency Monitoring and process Department improvement measures and reports Immunizations Targeted health education and self-care support 11
  12. 12. Kaiser Permanente’s Registry for ChronicDiseases and Panel Management ProvidesInsight Across Disease Spectrums Eight Major Clinical Registries:  Asthma  Heart Failure  Diabetes  Coronary Artery Disease  Chronic Kidney Disease  Cardiovascular  Hypertension  Panel Management 12
  13. 13. Kaiser Permanente’s Registry for ChronicDiseases and Panel Management ProvidesInsight For Each Chronic Disease Each member of the care team can access registry and panel management tools and play a role in addressing care gaps 13
  14. 14. Kaiser Permanente’s Registry for ChronicDiseases and Panel Management Can BeUsed for Physician Panel Management 14
  15. 15. Kaiser Permanente Members ActivelyParticipate in Care Through kp.org Member contacts with the health system increase through new modalities • More than 2.4 million Kaiser Permanente members have access to secure health information management features • 160,000 access kp.org daily • More than 10 million test results viewed in 2007 • More than 3.6 million secure e-mails sent to physicians in 2007 • 20,000 secure e-mails daily KP HealthConnect www.kp.org Make/Change Appointments Care Delivery Core Member Web Portal Send messages to doctor Outpatient Inpatient Scheduling Scheduling Check lab results Registration Access health Information Registration Clinicals Access medical record Clinicals Billing Refill prescriptions Pharmac On-line patient education, self- Billing ycare modules and support provide access to information 24/7. Emergency Make payments Department 15
  16. 16. Electronic Medical Records Make Tracking EasyBut Achieving Better Outcomes for PatientsRequires Using This Information to Drive Change  Kaiser Permanente needed a way to use the information in the electronic medical record to impact the patient’s total health.  Every patient encounter in primary care and in specialty care creates an opportunity to provide total care.  Staff are charged with overseeing all aspects of patient care and determining what vital tests or screenings are missing.  Appointments can be made on the spot or referrals generated so gaps can be readily addressed.  This leads to proactive care instead of reactive care after someone presents with critical signs and symptoms.  Kaiser Permanente’s experience shows that patients who have the largest “gaps” in recommended care do not routinely visit their primary care physicians. Specialty clinics must play a role to achieve optimal results • Fewer than 40% of patients needing a mammogram or testing for diabetes HbA1c visited their primary care physician 16
  17. 17. Proactive Encounters Have Revolutionized How Kaiser Permanente Provides Total Health• Not all patients see their primary care physician.• Every office encounter has been redesigned to optimize each patient contact.• Areas of need are identified and acted on.• All staff have responsibility for patient’s total health. Pre Encounter Office Encounter Post Encounter Proactive Office Encounter Management Immediate Identification • Vital sign collection / • After visit summary, • Identify missing documentation after care labs, screening • Identify and flag alerts for provider instructions, follow- procedures, access up appointments, management, kp.org • Room and prepare patient for Health Ed materials, status, etc. necessary exams how to access info • Provide member • Pre-encounter follow-up on kp.org instructions prior to Future visit Back Office Support • Follow-up contact • Contact member and • Phone calls and appointments document encounter • Letters per provider in KP • E-mail HealthConnect™ • Inbox Management 17
  18. 18. The Ability to Use, Not Just Store, InformationElectronically Results in Better Outcomes Examples Include:  Proper use of surgical antibiotics results in fewer surgical site infections.  Higher screening rates result in more cancer detection at earlier stages  Better blood pressure control results in fewer heart attacks and hospitalizations for related diseases.  Better osteoporosis management results in fewer hip fractures among the elderly population. 18
  19. 19. Proactive Office Encounter:Tools for Staff and Physicians to Fill Care Gaps Special tools and systems have been designed so each member of the care team can understand responsibilities and track results. • Panel Management • Pre-Encounter, Encounter Checklists • Proactive Care Gap Checklist • Proactive Encounter Performance Tool • Proactive Encounter SmartSets (KPHC) • Utilization Reports 19
  20. 20. Proactive Care Gap Checklist Gaps in the patients care are identified through the use of flags. If there is a “Y”, an action is needed. Member Information 20
  21. 21. Outcomes: Breast Cancer ScreeningRate (ages 52–69) – #1 in the U.S. 90% 88% 86% 84% National 90th 82% percentile 80% 78% YE 2004 YE 2005 YE 2006 YE 2007 through 10/08  Kaiser Permanente Southern California is #1 HMO in the country for breast cancer screening because of ability to see who in the defined population has not had a mammogram and schedule an appointment (often the same day) no matter why the patient was being seen originally.  565 lives saved per decade  4,349 Stage 4 cases prevented per decade 21
  22. 22. Outcomes: Colorectal Cancer Screening70%65%60% 27% Increase National 90th55% in 4 Years percentile50%45%40%35% YE 2004 YE 2005 YE 2006 YE 2007 through 10/08  Ability to view medical record electronically allow staff to see who in defined population needs an appointment for screening.  3,838 lives saved per decade 22
  23. 23. Outcomes: Controlling High BloodPressure (ages 18-85)85%80% 35.6% Increase in 4 years75%70%65%60% National 90th percentile55%50%45%40% YE 2003 YE 2004 YE 2005 YE 2006 YE 2007 through 10/08  Compliance with regular testing and medication are easily captured and reviewed.  4,890 lives saved per decade 23
  24. 24. Outcomes: Osteoporosis Management 65% 60% 55% 50% 45% 40% National 90th 35% percentile 30% 25% YE 2005 YE 2006 YE 2007 through 10/08  Proactive measures can reduce hip fracture rates by an average of 37.2 percent—and as much as 50 percent—among those at risk.  National 90th Percentile for Medicare is 30%. 24
  25. 25. Outcomes: Decreased Hip Fractures by Almost40% Due to Proactive Measures 37% total reduction in hip fractures in older women Hip fractures in older women lead to many complications including: • Lack of mobility • Inability to provide self- care • Expensive nursing home care • Death 25
  26. 26. Selected Hospital Outcomes in KaiserPermanente Kaiser Permanente Southern California has made dramatic gains in important hospital measures in less than two years.100%95% Heart Failure Bundle90% SCIP Composite85%80%75%70%65%60%55%50% 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 26
  27. 27. Better Hospital Outcomes in KaiserPermanenteSouthern California NNSI National BSI 4.0 Kaiser Permanente Rate 3.5 Southern California 3.0consistently performs better 2.5 KP Southern than most in important California BSI 2.0 hospital infection-control Rate/1000 Line Days 1.5 measures: Bloodstream 1.0 Infections and Hospital- 0.5 Acquired Pressure Ulcers. 0.0 07Q3 07Q4 08Q1 08Q2 08Q3 0.10 California HAPU 0.08 Rate 0.06 0.04 0.02 KP Southern California HAPU Rate 0.00 3Q2007 4Q2007 1Q2008 2Q2008 3Q2008 27
  28. 28. Hospital Outcomes in Kaiser PermanenteSouthern California Kaiser Permanente Southern California consistently performs better than the Medicare average for hospital standardized mortality rate.80% KP Southern California US Medicare Overall75%70%65%60%55%50% 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 * 3Q2008 Medicare hospital mortality not available 28
  29. 29. Kaiser Permanente Has Higher CancerSurvival and Lives Saved Annually Comparedto National Data KP 5-yr SEER 5-yr Lives survival survival* saved/yrBreast 92.3% 88.6% 107Colon 72.9% 64% 132Melanoma 97.9% 91% 76* SEER = Surveillance Epidemiology and EndResults, part of the National Cancer Institute.These data are for five-years survival rates. 29
  30. 30. Kaiser Permanente Addresses the Larger Healthcare Needs of the Community Focus on primary care and prevention, and addressing chronic disease requires looking at larger communitywide issues Behavioral factors are as important as specific treatments: better diet, reducing smoking, addressing the epidemic of obesity, greater physical activity Community education for adults and children in recognizing bad health habits and taking action to create a better health outlook 30
  31. 31. Healthy Eating Active Living Program HelpsMake Healthy Choices Easy1. Incorporate health into local planning decisions2. Increase access to parks and green spaces3. Improve public access and safety in recreation areas4. Develop collaborations with schools5. Establish safe routes to school6. Promote menu labeling and making nutrition information available to consumers7. Increase availability of healthy foods, including fruits and vegetables8. Promote healthy eating in public facilities9. Publicly recognize civic involvement and leadership10. Healthy choices start with you 31
  32. 32. HEAL and Operation Splash inSouthern California Healthy Eating, Active Living Partnership with The California Endowment (Healthy Eating, Active Communities) HEAL grants are focused on policy and environmental change Operation Splash Subsidized swim lessons, extended pool season, supplies healthy eating active living 32
  33. 33. The Amazing Food Detective:Working on better nutrition to helpstem the rise of childhood obesityProfessional theatre troupeperformances and workshopsfor 4th graders and parents• 227 performances• 571 workshops• 57K kids and parentsNow a computer game:www.kp.org/amazingfooddetective 33
  34. 34. Farmer’s Markets at Medical CentersWorking With Local Vendors 7 farmer’s markets at medical centers and Kaiser Permanente Watts Learning Center provide access to health foods for communities that do not often have easy access to fresh fruits and vegetables and health snacking alternatives.Farmer’s Markets include:Fresh produceCooking demonstrationsWellness literature 34
  35. 35. Kaiser Permanente Works with the Trustfor Public Land to Encourage More ActiveLifestyles Creates open space in park-poor neighborhoods and installs Fitness Zones.  In Southern California, Kaiser Permanente has a three-year partnership with the Trust for Public Land. Through a $750,000 grant, the Trust is assisting underserved, park-poor communities with planning, land acquisition, and grant development.  The grant also funds planning and development of fitness zones – exercise equipment that people of all ages can use. Five fitness zones have been installed in five Los Angeles County parks in low-income neighborhoods with high rates of obesity. 35
  36. 36. This old rail road right-of-way wasalong the southeast corridor of LosAngeles County. 36
  37. 37. Here’s the same site and what itlooks like today thanks to the Trustfor Public Land. 37
  38. 38. These “abuelitas” or grandmothers are working out inBelvedere Park in East Los Angeles. The Trust for PublicLand developed the Fitness Zone model and works onmatching grants to install the equipment in low-incomeneighborhoods. 38
  39. 39. Kaiser Permanente launched anadvertising campaign – called“Thrive” – which emphasizes ahealth message for the community 39

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