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Why would a physician and a health system executive be interested in transportation? A conversation with nationally recognized Arlington, VA Mobility lab, and myself and Keith Montgomery, Executive ...

Why would a physician and a health system executive be interested in transportation? A conversation with nationally recognized Arlington, VA Mobility lab, and myself and Keith Montgomery, Executive Director of the Center for Total Health

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Transportation and Total Health - Arlington Mobility Lab Lunch and Learn Presentation Transcript

  • 1. Transportation and Total Health Lunch at the Lab • October 10, 2013 Ted Eytan, MD, Physician Director • Keith Montgomery, Executive Director Kaiser Permanente Center for Total Health, Washington, DC USA Photo: M.V. Jantzen - http://www.flickr.com/photos/mvjantzen/8464490630/
  • 2. Transportation and Total Health Lunch at the Lab • October 10, 2013 Photo: Ted Eytan, MD - http://www.flickr.com/photos/22526649@N03/9720976367
  • 3. We’re here from the future Kaiser Permanente Center for Total Health • @kptotalhealth
  • 4. My story http://bit.ly/walkingmeetings
  • 5. doctor | th 19 century
  • 6. §24/7 access worldwide §9,000,000 members can –email their doctor –check lab test results –order prescription refills –manage appointments §iOS, Android, Blackberry patient | st 21 century
  • 7. Medical Care (and health) only happens here?
  • 8. Health happens here
  • 9. Health happens here La Mesa Medical Offices, California Photograph: Ted Eytan, MD, http://www.flickr.com/photos/taedc/8382776635/
  • 10. The most HEDIS #1’s Effectiveness of Care Measures 41 Kaiser Permanente #1’s • Comprehensive diabetes 31 21 10 2011 9 0 Medicare care — LDL control less than 100 mg/dl (Hawaii Region) • Osteoporosis management in women who had a fracture (Northern California Region) • Breast cancer screening, age 42–69 (Northwest Region) • Pharmacotherapy Management of chronic obstructive pulmonary disease (COPD) exacerbation — bronchodilator (Northwest Region) • Cholesterol management (coronary artery disease), LDL level less than 100 mg/ dl (Colorado Region) • Follow-up after hospitalization for mental illness — 30 days (Colorado Region) • Controlling high blood pressure — cardiovascular (Hawaii Region) • Potentially harmful drugdisease interaction — total (Hawaii Region) • Weight assessment for adults — body mass index percentile (Georgia Region) • Weight assessment for 11 Commercial children — body mass index percentile • Counseling for nutrition for children • Counseling for physical activity for children • Chlamydia screening in women (ages 16–20, 21–24 and total) • Appropriate testing for children with pharyngitis • Appropriate use of medications for people with asthma (ages 12– 50, total) • Comprehensive diabetes care — LDL control less than 100 mg/dl • Comprehensive diabetes care — medical attention for nephropathy • Antidepressant medication management (effective acute phase) • Antidepressant medication management (effective continuation phase) • Annual monitoring for patients on persistent medications — anticonvulsants
  • 11. The most HEDIS #1’s Effectiveness of Care Measures Kaiser Permanente #1’s • Breast cancer screening, 41 31 21 10 2012 13 0 Medicare Source: Kaiser Permanente Newe Center, http://xnet.kp.org/ newscenter/pressreleases/nat/ 2012/101012_ncqa_care_measures.html ; http://xnet.kp.org/ newscenter/pressreleases/nat/2012/112812-ncqa-medicaremeasures.html age 42–69 (Southern California) • Use of Spirometry Testing in the Assessment of COPD (Hawaii Region) • Pharmacotherapy Management of COPD Exacerbation — Bronchodilator (Southern California) • Cholesterol management (coronary artery disease), LDL Screening (Hawaii) • Cholesterol management (coronary artery disease), LDL level less than 100 mg/ dl (Colorado) • Controlling high blood pressure — cardiovascular (Ohio) • Comprehensive diabetes care — HbA1c Testing (Hawaii) • Comprehensive diabetes care — LDL level less than 100 mg/dl (Northern California) • Comprehensive diabetes care — Medical Attention for Nephropathy (Colorado) • Comprehensive diabetes care — blood pressure control (<140/80) (Georgia) • Comprehensive diabetes care — blood pressure control (<140/90) (Colorado) • Osteoporosis management in women who had a fracture (Southern California) • Potentially harmful drugdisease interaction — Dementia (Hawaii) 16 Commercial • Breast cancer screening • Comprehensive diabetes care — blood pressure control (<140/80) • Comprehensive diabetes care — blood pressure control (<140/90) • Comprehensive diabetes care — medical attention for nephropathy • Antidepressant medication management (effective acute phase) • Antidepressant medication management (effective continuation phase) • Weight assessment for children — body mass index percentile • Counseling for nutrition for children • Counseling for physical activity for children • Chlamydia screening in women (ages 16–20, 21–24 and total) • Appropriate treatment for children with upper respiratory infection • Avoidance of antibiotic treatment in adults with acute bronchitis • Use of spirometry testing in assessment & diagnosis of chronic obstructive pulmonary disease • Annual monitoring for patients on persistent medications — anticonvulsants • Medical assistance with smoking cessation — advising smokers to quit • Medical assistance with smoking cessation — discussing strategies
  • 12. The most HEDIS #1’s Effectiveness of Care Measures 2013 Kaiser Permanente #1’s 41 • Adult BMI Assessment • Weight Assessment for 31 21 13 10 0 Medicare Source: KP Share, http://share.kaiserpermanente.org/article/kaiserpermanente-leads-the-nation-in-13-commercial-health-plan-qualitymeasures/ Commercial Children • Counseling for Nutrition for Children • Counseling for Physical Activity for Children • Breast Cancer Screening • Cervical Cancer Screening • Chlamydia Screening in Women (Ages 16-20, Ages 21-24, and Total) • Use of Spirometry Testing in Assessmand & Diagnosis of COPD • Controlling High Blood Pressure • Comprehensive Diabetes Care - Eye Exams • Comprehensive Diabetes Care - Medical Attention for Nephropathy • Comprehensive diabetes care — blood pressure control (<140/80) • Comprehensive diabetes care — blood pressure control (<140/90)
  • 13. What will happen with diabetes? Pre-diabetes 20131 852,301 52% develop diabetes 29% develop over 10 over diabetesyears23 years2 New cases of diabetes by 2016 247,167 members with type 2 DM in 20123 477,383 New cases of diabetes by 2023 443,197 1 – Preliminary data; Care Management Institute Analysis March 2013. 2 – Diabetes Prevention Research Group; Diabetes Prevention Program 3 – Preliminary data; CMI Analysis, as of March 31 2012. CORE KP HEDIS Diabetes cohort, minus expected % of Type 1 diabetes per CDC national prevalence
  • 14. If physical activity were a drug... activated activated activated deactivated it works Source: Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nature Reviews. Neuroscience. 2008;9(1):58–65.. Slide created by Ted Eytan, MD | @tedeytan | December, 2012 tm better
  • 15. The Obesity Paradox 14,345 men , average 7 year follow-up men who became fit or remained fit had approximately 40– 50% lower risks of all-cause and CVD mortality BMI status change was not significantly associated with either all- cause or CVD mortality Source:Lee D, Sui X, Artero EG, et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 2011;124(23):2483–90. Available at: http://circ.ahajournals.org/content/124/23/2483.abstract [Accessed October 8, 2013]. Image © American Heart Assocation
  • 16. Exercise as Vital Sign § “I would suggest it makes more sense to stop measuring blood pressure at every visit than to ignore our patient’s exercise habits, because we know that being sedentary is a bigger risk factor for mortality than mild to moderate levels of hypertension” – Bob Sallis, MD Source: Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br. J. Sports Med. 2011;45(6):473–474. Available at: http://bjsm.bmj.com/content/45/6/473.short. Smith, John W
  • 17. Soon, with upload to the cloud
  • 18. It’s not just me Bob Sallis, MD and Matt Sallis Rosemary Agostini, MD
  • 19. Our patients notice “Kaiser (Permanente) is so far past faxing orders that they’re into sustainable apples” -Jess Jacobs, April, 2013, TEDMED http://http://jessjacobs.me/my-intravenous-lecture/
  • 20. 1992
  • 21. obesity rate: 12.5% 2013
  • 22. 2013
  • 23. 2013
  • 24. 2013
  • 25. Total Health requires collaboration
  • 26. Changing our mental models
  • 27. An integrated approach to total health and productivity @ the Worksite Manage employees’ current health conditions Understand their health risks Health Plan and Medical Group 1 Encourage employee health Prevent future costs
  • 28. Reports: Prevention and lifestyle dashboard Your Results, 2008 Q4 Your Results, 2009 Q3 Year-Over-Year Change Measure BMI: weight management % of adult members who are overweight or obese 73.4% 73.6% Declined Cholesterol management % of members borderline high or high total cholesterol 36.3% 36.8% Declined Blood pressure management % of members with blood pressure >=140/90 11.3% 11.6% Declined Smoking rates % of members who smoke 12.8% 12.4% Improved Breast cancer screenings* % of eligible population screened 85% 86.7% Improved Cervical cancer screenings* % of eligible population screened 86% 85.6% Declined Colorectal cancer screenings* % of eligible population screened 64.9% 63.6% Declined Childhood immunization rates* % of eligible population screened 85.2% 81.3% Declined Childhood obesity * Description % of child members who are overweight or obese 35.9% 36.2% Declined Continuously enrolled members during measurement period. Insufficient sample size (ISS) will be displayed if the number of eligible members for the prevention measure falls below 30. 2
  • 29. Reports: Chronic conditions 3
  • 30. Reports: Value summary
  • 31. Prevent future costs How to Get Started Resources
  • 32. Thrive Across America The workforce health program with proven results
  • 33. Exercise = better health and lower costs Only 5% of Americans exercise regularly* Each year, inactive people can cost you: 5% $323 $4,927 More in absenteeism costs 7 $622 More in direct medical costs More in health costs for chronic conditions
  • 34. Log on for a healthier workforce Online Physical Activity Program 8
  • 35. Beyond HealthWorks • Community Benefit • Thriving Schools, Fire Up Your Feet • Walking Summit – October 1-3 • 100+ partners • 20 partners in “Share Fair” • 400 total attendees • Digital Health Technology Exploratorium • 3 formal walking meetings • 12 capacity building sessions • Proposed call to action by the Surgeon General 9
  • 36. thank you