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Plenary Session Kaiser Permanente Healthcare It Journey


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eHealth Week 2012 Presentation by George C. Halvorson
Chairman and Chief Executive Officer
Kaiser Permanente

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Plenary Session Kaiser Permanente Healthcare It Journey

  1. 1. 5/9/2012Kaiser Permanentes Healthcare IT Journey George C. Halvorson Chairman and Chief Executive Officer Kaiser Permanente Kaiser Permanente Kaiser Permanente is both a health care delivery system and a health insurance/financing mechanism. 2 1
  2. 2. 5/9/2012 We provide all elements of care: Hospitals Clinics Labs Pharmacies Image Centers Etc. 3 Kaiser Permanente We are the largest privatemedical groups in the world and we are one of the largest hospital systems in the U.S. 4 2
  3. 3. 5/9/2012 Kaiser Permanente We serve nine million member/patients. 5 Kaiser PermanenteWe employ 180,000 workers -- almost all in care delivery. 6 3
  4. 4. 5/9/2012 Kaiser Permanente We have annual revenues of $50 billion dollars. 7 Kaiser Permanente We are “prepaid” for our care. We sell a total package of care.We are not paid based on separate fees that are charged for separate pieces of care. 8 4
  5. 5. 5/9/2012 Kaiser Permanente FlexibilityWe can use the $50 billion we receive in revenue to provide the care that our patients need… rather than justdelivering the pieces of care to patients that build a FFS piecework revenue stream for us. 9 Kaiser Permanente We are accountable for the total care -- and for the total health -- of our nine million members. 10 5
  6. 6. 5/9/2012 Kaiser Permanente We need to make smart decisions about how wedeliver care and how we create health. 11 Kaiser Permanente We know that -- Care costs are not evenly distributed. 12 6
  7. 7. 5/9/20121314 7
  8. 8. 5/9/2012 15 What does that tell us?It tells us to focus and it tells us to intervene. 16 8
  9. 9. 5/9/2012Who are the patients that are creating the major costs of care? 17 Are the high cost patients cancer, contagious disease,broken bones and lacerations, and acute care patients? 18 9
  10. 10. 5/9/2012 Do we spend most health caredollars on cancers, cuts, contusions, concussions, and colds? 19 NO. 20 10
  11. 11. 5/9/2012 Cancer, contagious diseases,broken bones and lacerations, and acute care patients? Most care costs come from chronic conditions. 21 Chronic diseases create 75% of the costs of care Chronic Care 75% Acute Care 25% 22 11
  12. 12. 5/9/2012 Patients with multiple health conditions --co-morbidities -- create 80% of the costs of care. Co-morbidities 80% 20% 23 How is that information useful to us? 24 12
  13. 13. 5/9/2012 1) It tells us where to focus. 252) It tells us how to make a real difference in care and costs. 26 13
  14. 14. 5/9/2012 Patients with co-morbiditiesand chronic conditions need -- TEAM CARE 27 We need the right care and we need consistent care… with teams of caregivers focused on the needs of individual patients. 28 14
  15. 15. 5/9/2012 Chronic Care PatientsQuestion:Do you want your health care provider towork as a team to coordinate your care? Answer: YES (97%) 29 Chronic Care PatientsQuestion:Do your health care providers work as ateam to coordinate your care? Answer: No (46%) 30 15
  16. 16. 5/9/2012 How can we create team care, connected care, right care, and best care? 31Think Tools -- We need care support tools to help make that work possible. 32 16
  17. 17. 5/9/2012 What tools do we need? 1. Data 2. Connectivity 3. Continuous improvement skills and processes 4. Care support protocols and tools 33 The Prime Directive:Make the right thing easy to do! 34 17
  18. 18. 5/9/2012To make the right thing easy to do, we need to:1. Figure out the right thing.2. Make it easy to do. (Make the right thing easy to do is the CMI mantra and the systems commitment at Kaiser Permanente) 35 Paper medical records are ahuge impediment to care quality and care improvement. 36 18
  19. 19. 5/9/2012 Paper is isolated, inaccessible, not interactive, incomplete, and often inaccurate. Paper is -- at its best -- inert. 37Paper is isolated, inaccessible, notinteractive, incomplete, and ofteninaccurate -- it is at its best -- inert.Paper records do not and cannot makethe right thing easy to do. 38 19
  20. 20. 5/9/2012To deliver best care for each patient, we need real-timeinformation about all of ourpatients at the point of care. 39All All All (Mantra number two) 40 20
  21. 21. 5/9/2012 We very much need thecaregivers who share patients toshare data about their patients. 41 We also need real-time information about medical science and best practicesavailable to our caregivers at the point of care. 42 21
  22. 22. 5/9/2012 There are 60,000 medical journals published every year. Medical science changescontinuously. No caregiver can keep up on their own. 43 So what didKaiser Permanente do to go down those paths? 44 22
  23. 23. 5/9/2012 We invested four billion dollarsin building an electronic medicalrecord and a set of care support tools for our care sites and care teams. 45 We have real-time andcomplete electronic patientinformation for our doctors at the point of care. 46 23
  24. 24. 5/9/2012We have real-time information about most current medical science and best practices available for our doctors andcare teams at the point of care. 47 48 24
  25. 25. 5/9/2012 49 We also now have the dataneeded to track care and to doreal-time medical research and process improvement. 50 25
  26. 26. 5/9/2012We have completely linked our care delivery facilities -- withpaperless lab reports, electronic transmissions of tests, andelectronic care reporting for our hospital and medical care. 51We probably have the lowest insurance related administrative costs of any health plan in America. 52 26
  27. 27. 5/9/2012 We have the bestpatient/doctor connectivity -- through our electronicconnections to our patients. 53 We win just about every quality award in America. 54 27
  28. 28. 5/9/2012 Top HEDIS scores in 21 categories. 55 Medicare rated 459 healthplans -- using 53 quality and service measures. 56 28
  29. 29. 5/9/2012Health plans were rated from one to five stars. 57 Only nine health plans in America earned five stars. 58 29
  30. 30. 5/9/2012Five Kaiser Permanente Regionswon the full five stars -- and our lowest score for any KP Plan was 4.5 stars. 59 We won the “Star Wars” for Medicare. 60 30
  31. 31. 5/9/2012We were also rated number one as a health plan by J.D. Power & Associates. 61 You can look up our consumer ratings. 62 31
  32. 32. 5/9/2012The tool kit works. 63 Team Care Works Reduced broken bones by 43% Reduced HIV deaths to half the national average Reduced heart disease deaths by 30% 64 32
  33. 33. 5/9/2012 We also have set up important programs to support safe care. 65Sepsis kills more patients in American hospitals than cancer, heart disease or stroke. 66 33
  34. 34. 5/9/2012 We put data supported team care in place for our sepsis patients -- and we cut the death rate from sepsis by more than half. 67 Sepsis Hospital Mortality Rates0.25 0.20.15 0.10.05 0 39934 40756 39814 39845 39873 39904 39965 39995 40026 40057 40087 40118 40148 40179 40210 40238 40269 40299 40330 40360 40391 40422 40452 40483 40513 40544 40575 40603 40634 40664 40695 40725 40787 40817 Source: Joint Commission Journal on Quality and Patient Safety, November 2011 68 34
  35. 35. 5/9/2012If the rest of America had that same Kaiser Permanente sepsis response program in place, that would have saved 72,000 lives in America last year -- and reduced eight million very expensive hospital days. 69 Likewise -- with hospital acquired pressure ulcers --focused science based team care can make a huge difference. 70 35
  36. 36. 5/9/2012 Roughly 2.5% of patients in American hospitals get pressure ulcers -- and many patients are damaged and killed by those ulcers. 71Team care at Kaiser Permanente has reduced pressure ulcers by two thirds. 72 36
  37. 37. 5/9/2012Hospital-Acquired Ulcers (HAPU) Stage 2 Plus All KP Hospitals CalNOC Average4.0% CalNOC (2008) Average3.5%3.0% KP Average2.5%2.0%1.5%1.0%0.5%0.0% Q208 Q308 Q408 Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410 Q111 Q211 Q311 Q411 CalNOC consists of a coalition of California hospitals who are working together on patient safety issues. 73 Having extensive and available data about care facilitates both care improvement and care quality improvement agendas 74 37
  38. 38. 5/9/2012 Our Board of Directors focuses on quality as a major part of our governance process. 75 Our Kaiser Permanente Board of Directors Quality Committee meetsmore often and longer than our Board Finance Committee or our Executive Committee. 76 38
  39. 39. 5/9/2012We provide the KP Board and senior leadership with a monthly update on more than 200 measures of safety and quality. The Big Q 77 The Big Q report is available to any Board member at any time by electronic reporting. 78 39
  40. 40. 5/9/2012 -- We Steer Toward Quality --•Health Plan Quality •Quality Management•Healthcare Analytics •Resource Stewardship•Patient Safety •Risk Management•Performance Improvement •Service Quality•Population Health 79 80 40
  41. 41. 5/9/2012 HEDIS National 90th Percentile 81 Archimedes• KP also invests in leading edge technology such as Archimedes.• Archimedes is a person specific computer simulation model used to understand the likely health outcomes and costs of decisions from the policy level to individual patient decisions.• Archimedes is now assisting the European Health Checks project.• Targeted health checks for individuals at the highest risk are cost-effective. 82 41
  42. 42. 5/9/2012We focus on quality and we use our systems to support our quality improvement efforts. 83We also focus on connectivity. 84 42
  43. 43. 5/9/2012 Our website -- -- was used a hundred million times by our members and patients last year. 85 We started connecting with ourmembers on the internet in large scale efforts five years ago.Our member website -- -- was used more than a hundred million times last year. 86 43
  44. 44. 5/9/2012 Our patients can use the internet to: See their medical record Make appointments E-mail their doctors Order prescription refills Learn about their health or care 87 We sent out 60 million labresults electronically last year. 88 44
  45. 45. 5/9/2012 We believe that up to 40% offace-to-face patient visits might be done electronically. 89 We now do 40% of our dermatology visits with video links and e-connectivity. 90 45
  46. 46. 5/9/2012 Our new Android and iPhoneapp had nearly two million uses in the first month. 91 New Mobile Apps 92 46
  47. 47. 5/9/2012Patients love being connected. 93So where do we go from here? 94 47
  48. 48. 5/9/2012 The Four Sites of CareWe believe that care in the future will bedelivered in four distinct “sites of care.” 95 Site One -- Staffed Beds Hospitals Nursing homes Places where people sleep and care is delivered. 96 48
  49. 49. 5/9/2012Site one will be incredibly and increasingly well supported with great technology. 97 Site Two -- Face-to-Face Clinics, Offices Direct ambulatory caregiver encounters Exam rooms Wide array of care sites (Offices, work places/ vans / etc.) 98 49
  50. 50. 5/9/2012Site two will also be incredibly and increasingly well supported with great technology. 99 Site two technology will be diagnostic, therapeutic,communicative and remediative-- with full EMR connectivity and care linked to patient specific care plans. 100 50
  51. 51. 5/9/2012 Site Three -- In-Home Care The home will be a primary site of care. Care tools will be on-site in many people’s homes. 101Site three will be incredibly and increasingly well supported with great technology. 102 51
  52. 52. 5/9/2012 Some site three technology for in-home care two years from now will be as good or better than actual hospital inpatient technology was five years ago. 103 In-home monitoring, EKGs, ultrasounds, video conferences, blood and fluid diagnostic and testing tools and patient communication tools will be increasingly sophisticated, effective, and cheap. 104 52
  53. 53. 5/9/2012For most people, the home will be the primary site of care -- very well equipped to be a great site of care. 105In-home care will function best in the context of a care team who knows the patient’s total situation and full set of care needs. 106 53
  54. 54. 5/9/2012 Site Four -- The Web The internet will deliver a lot of care Connected, web-located care will expand rapidly Web care will be available everywhere, all of the time. 107Site four will also be incrediblyand increasingly well equippedwith great technology and tools. 108 54
  55. 55. 5/9/2012 Portable EKGs Care tracking Electronic consultsPerpetual monitoring -- linked to interventions. 109 Full data flow for each patientInteractive diagnostic work and care planning. 110 55
  56. 56. 5/9/2012Entirely current, completepatient specific care data -- at a very low cost. 111The world is now flat for a lot of care. 112 56
  57. 57. 5/9/2012 Next steps?Continuous learning will be the future of health care. 113 DNA and Causality Research 114 57
  58. 58. 5/9/2012 Research Question: When mothers have a uterine infection during pregnancy --does that create higher asthma risk for their kids? 115 Answer: YESThe asthma risk is a lot higher for the kids. 116 58
  59. 59. 5/9/2012 How much higher?African American kids 98% increase Source: Archives of Pediatric and Adolescent Medicine 117 How much higher? Hispanic kids 70% increase Source: Archives of Pediatric and Adolescent Medicine 118 59
  60. 60. 5/9/2012 How much higher? Caucasian kids 66% increase Source: Archives of Pediatric and Adolescent Medicine 119 How much higher?Asian American kids ??? Source: Archives of Pediatric and Adolescent Medicine 120 60
  61. 61. 5/9/2012 How much higher? Asian American kids Zero % increase Source: Archives of Pediatric and Adolescent Medicine 121There was no additional risk for Asian American kids. 122 61
  62. 62. 5/9/2012 African Americans 98% increase Hispanics 70% increase Caucasians 66% increase Asian/Pacific Islanders 0% increase Source: Archives of Pediatric and Adolescent Medicine 123KP is currently collecting DNA data.200,000 samples -- stored in Berkeley. 124 62
  63. 63. 5/9/2012 Chronic Care PatientsAll Patients:My health care data should be used to helpimprove the care of future patients who mighthave the same or similar conditions. Agree: 89% Strongly Disagree: 3% 125 One use of that data will be to figure out what might be a genetic factor for the asthmatic kids. 126 63
  64. 64. 5/9/2012 Electronic data lets us discover unexpected linkages and unsuspected causalities. 127 Alzheimer’s Research High 260% higher (longitudinal cholesterol Alzheimer’s rate data -- long time in 30s in 70s members)Hypoglycemic 80% higher rate (two attacks -- of Alzheimer’s 160% higherattack pre-60s in 70s rate) 172% increasedHeavy smokers 157% increased risk of vascular risk of in mid life dementia two Alzheimer’s decades later (EMR Applied to Longitudinal Research) 128 64
  65. 65. 5/9/2012 Autism Studies 30% Higher for older mothers 50% Higher for older fathers 129The risk of autism for children was three times higher when the mothers to be took a particular drug in the first trimester ofpregnancy and twice as high if themother took that same drug in the second trimester. 130 65
  66. 66. 5/9/2012 Which trimester is the higher risk? 131 No one suspected any linkbetween that drug and Autism -- until the Kaiser Permanente study was done. 132 66
  67. 67. 5/9/2012Kaiser Permanente patient dataresulted in Vioxx being removed from the marketplace. 133 We need electronic data. 134 67
  68. 68. 5/9/2012We need electronic data to improve care. 135We need electronic data to improve science. 136 68
  69. 69. 5/9/2012We need electronic data to save lives. 137We need electronic data to link caregivers. 138 69
  70. 70. 5/9/2012So Kaiser Permanente is building a tool kit and learning to use the new tool kit to make care better, safer, more accessible, smarter, and less expensive. 139 We spent four billion dollarsat KP on computer based care support tools. 140 70
  71. 71. 5/9/2012Our annual cost and expense level is more than five billion dollars ayear below where it would be if we did not have those tools. 141 It’s a good time to use computers to support care. 142 71
  72. 72. 5/9/2012Be well 143 72