The document discusses how Kaiser Permanente improves health care quality through integrated teams. It describes Kaiser Permanente's model of providing comprehensive, high-quality and affordable care through integrated multi-specialty medical groups and hospitals. The model is enabled by a fully integrated electronic medical record system and performance measurement tools that support coordinated, population-based care and continuous quality improvement.

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