1.
Improving Health Care Quality
Through Integrated Teams
WoHIT Barcelona March 17, 2010
Hal Wolf
Sr. VP COO
The Permanente Federation, LLC

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”
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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
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4.
International Rankings and National
Health Expenditures

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.
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
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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
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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.
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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.
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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.
Panel Management
 Population Care Management. Born from the development of Registries.
$ 6 million/year
0
2000+
CVD
DC
HTN
15% Panel 85%

12.
Standard Patient Categorizing
Primary Secondary Acute Chronic
Patient
Sort
Standard
Complex Known
Dx
Sort Standard
Dx Process

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.
Key Success Factors
 Clear, agreed upon, mission
 Strong, dedicated leadership
 Aligned structure and incentives
 Integrated information technology and performance
improvement
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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
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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
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17.
It’s Not the Box
OO + NT = COO

18.
It’s Not the Box
OO + NT = COO
Old organization + New Technology = Costly Old Organization