Improving Health Care Quality Through Integrated Teams

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Improving Health Care Quality Through Integrated Teams. Wolf H. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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Improving Health Care Quality Through Integrated Teams

  1. 1. Improving Health Care Quality Through Integrated Teams WoHIT Barcelona March 17, 2010 Hal Wolf Sr. VP COO The Permanente Federation, LLC
  2. 2. Health Care’s Common Challenges  Access to / timeliness of care  Costs  Quality gaps and variation – overuse, underuse, misuse  Increasing prevalence of chronic diseases  Need for improved coordination across “system” 2
  3. 3. About Kaiser Permanente • Nation’s largest nonprofit health plan • Integrated health care delivery system • 8.6 million members • 14,600+ physicians • 167,000+ employees • Serving 9 states and the District of Columbia • 35 hospitals and medical centers • 431 medical offices • $40.3* billion annual revenues * 2008 revenues 3
  4. 4. International Rankings and National Health Expenditures
  5. 5. US data collated by Professor Bill Runciman, Closing President, Australian Patient Safety the Gap Foundation from McGlynn et al; NEJM 2006 Vol 348; p2635-45 © 2008 Map of Medicine Ltd and Zynx Health Inc.
  6. 6. IOM’s Six Major Challenges “Organizations will need to negotiate successfully six major challenges.”  Redesigned care processes based on best evidence  Effective use of information technology  Knowledge and skills management  Development of effective teams  Coordination of care across conditions, services, and settings  Use of performance and outcomes measurement for continuous improvement and accountability 6
  7. 7. Growing Consensus About Ideal Care  Accountable Care Organizations  Provides (or can effectively manage) continuum of care as a real or virtually integrated local delivery system  Sufficient size to support comprehensive performance measurement  Patient-Centered Medical Home  Personal physician  Physician directed medical practice  Whole person orientation  Care is coordinated and/or integrated  Quality and safety  Enhanced access to care  Payment that supports coordinated, comprehensive care supported by information and communication technologies 7
  8. 8. Guided by Mission and History The Kaiser Permanente Mission: To provide affordable, high-quality health care services to improve the health of our members and the communities we serve. 8
  9. 9. Role of Communities Healthy communities and a healthy environment are critical to individual health and wellness, but there is a disparity in what we fund. 9
  10. 10. The Physician Role Changes The Traditional Model  One Patient at a time of Care  Only Know about patients who appear in your office  No use of IT  Limited use of extenders New Model Elements  Accountability for panel/population  Transparency  Use of EMR, registries, internet  Moving care out of the Dr. office
  11. 11. Panel Management  Population Care Management. Born from the development of Registries. $ 6 million/year 0 2000+ CVD DC HTN 15% Panel 85%
  12. 12. Standard Patient Categorizing Primary Secondary Acute Chronic Patient Sort Standard Complex Known Dx Sort Standard Dx Process
  13. 13. Integration  Integration along multiple dimensions  Financing and medical care  Primary care, specialty care, ancillary providers, and ancillary diagnostic and therapeutic services  “Continuum of care”-home, provider office, hospital , nursing home/SNF  Continuum of an illness-primary and secondary prevention, diagnosis, treatment, chronic care management and follow- up, supportive care, and palliative care  Integration over time
  14. 14. Key Success Factors  Clear, agreed upon, mission  Strong, dedicated leadership  Aligned structure and incentives  Integrated information technology and performance improvement 14
  15. 15. Supported by Structure and Incentives  Compensation structure support aligned incentives and shared accountability  Multispecialty medical groups enable coordinated care  Interdisciplinary care teams support spectrum of patient needs across conditions, services, and settings  Integration encourages population perspective and commitment to resource stewardship 15
  16. 16. Enabled by Information Technology and Performance Measurement  Fully functioning, fully integrated EMR  Kaiser Permanente HealthConnect  My Health Manager  Frequent, ongoing use of performance and outcomes measures for continuous improvement and accountability 16
  17. 17. It’s Not the Box OO + NT = COO
  18. 18. It’s Not the Box OO + NT = COO Old organization + New Technology = Costly Old Organization

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