Transcript Slide 1

Health Care. Women of Color Get It
Kaiser Permanente
True Integration: Different… Better…
Susan Leggett-Johnson, MD MBA
Typical U.S. health care model
Typical: Fragmented, uncoordinated
Result: High cost, frequent duplication of efforts, low efficiency, difficult to navigate
Call Center
Advice Center
Primary Care
Office
Media/Web
Laboratory
Specialty Care
Office
Skilled Nursing
Facility
Hospital
Home
(Self-Care)
Urgent Care
Rehabilitation
Health
Plans
DM Vendors
Hospice
Emergency Room
Pharmacy
Radiology
Clinical Integration: EMR fulfilled
Population
Management Tools
KP
Health Connect
Labs
Inpatient
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Outpatient
Emergency
Pharmacy
Imaging
Immunization
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Secure Web-Based
Universal Access
Real Time
Linked to Delivery
System
Electronic Ordering
Digital Imaging
Secure Messaging
Membership
Financial &
KP.org and
My Health Manager
Benefits
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© 2012 Kaiser Foundation Health Plan, Inc. For internal use only.
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Disease registries

Risk stratification

Identification of
subgroups needing care
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Patient management tools

Targeted panel lists
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Inreach - Prompts,
reminders for clinicians
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Outreach - Letters and
automated telephone
outreach to members
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Monitoring and process
improvement measures
and reports
Vertical Integration: Beyond contracts
Kaiser Foundation
Health Plan
Facility Network
(Kaiser owned/operated +
partner hospitals)
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© 2012 Kaiser Foundation Health Plan, Inc. For internal use only.
Mid-Atlantic Permanente
Medical Group
Impact: Quality
2011 Maryland HMO/POS Plan Summary of Performance Ratings
Count of measures with above average performance
Treatment and Management Care
Screening and Preventive Care
35
15
19
11
8
4
4
Aetna
12
6
7
4
12
7
Blue Choice CIGNA
20
6
Coventry
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© 2012 Kaiser Foundation Health Plan, Inc. For internal use only.
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Kaiser
M.D. IPA
Permanente
SOURCE: Maryland Healthcare Commission: 2011 Comprehensive Health Benefit Plan Performance Report
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4
2
0 2
OCI
2
2
United
Healthcare
When seen by KP Provider
When seen in the community
Impact: Accessibility
Wait Time from referral initiation to appointment completion for KP Members*
Number of days from initiation of referral to completion of specialist office visit
31
29
26
26
26
25
24
24
25
25
24
21
28
21
21
20
21
20
19
17
16
16
14
12
11
10
8
8
ALL
ANE
AUD
11
9
9
GI
ONC
ID
12
11
10
9
9
7
CAR DRM END
14
13
13
13
12
NEP
NEU
OPH
7
7
6
ENT
PHY
PT
POD
PUL
RHE
SLP
8
7
8
SUR
ORT
PLS
Between one-quarter and one-third of patients are seen by
specialists the same or next day from their primary care encounter
* Data is from April 2012 (lagged 3 months from current so that claims data can be processed to ensure we know when external providers saw the patient); results are
reflective of what is seen every other month
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© 2012 Kaiser Foundation Health Plan, Inc. For internal use only.
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VAS
10
URO RAD
Access + Quality = Satisfaction
JD Power Member Satisfaction Scores*
(Commercial Health Plans in the Virginia-Maryland-D.C. Region)
+17
768
751
697
Kaiser
Permanente
(#1 scoring plan)
Sector Average
2011
701
Kaiser
Permanente
(#1 scoring plan)
Sector Average
2012
*Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., received the highest numerical score among commercial health plans in the Virginia-Maryland region in the
proprietary J.D. Power and Associates 2012 U.S. Member Health Insurance Plan Studies.SM 2012 study based on 32,868 total member responses, measuring 6 plans in the
Virginia-Maryland-D.C. region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed December 2011–
January 2012. Your experiences may vary. Visit jdpower.com
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© 2012 Kaiser Foundation Health Plan, Inc. For internal use only.
Access + Quality = Satisfaction
2011 Maryland HMO/POS Plan Summary of Performance Ratings for Satisfaction
With the Experience of Care: Count of measures with above average performance
7
1
0
Aetna
0
Blue Choice CIGNA
1
0
Coventry
Kaiser
M.D. IPA
Permanente
SOURCE: Maryland Healthcare Commission: 2011 Comprehensive Health Benefit Plan Performance Report
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© 2012 Kaiser Foundation Health Plan, Inc. For internal use only.
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0
OCI
United
Healthcare
One example of Kaiser Permanente Quality –
Breast Cancer Screening 2008-2011
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Data source: HEDIS
Access + Quality = Satisfaction
CAHPS: 2011 Overall Health Care Rating
KPMAS versus Competitor HMO and PPO Plans
Percent respondents rating plan as 9 or 10 out of 10
KPMAS
Aetna
CareFirst
MD IPA
Optimum Choice
Aetna PPO (MD/DC)
Kaiser
Permanente
Mid-Atlantic
All the
other
plans
CAHPS is an abbreviation for the Consumer Assessment of Healthcare Providers and Systems. CAHPS performs an annual assessment of HMO customer satisfaction
designed by the NCQA. PPO results not reported in 2007. The initial State of MD annual report did not have results for Overall Health Care Rating so don’t have a score
for BluePreferred. That score should be included in the State’s detailed 2011 report which should be available in December.
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January 23, 2012
Rank – nationally among private (commercial) plans
Quality + Service = Highest NCQA Ranking
2011 NCQA Health Insurance Plan Ranking
1
33
50
100
KPMAS
73
CIGNA
81
Aetna
150
CareFirst
200
United
250
2009
2010
2011
NOTE: The “NCQA’s (National Committee for Quality Assurance) Health Insurance Plan Rankings” is based on combined scores for health
plans in Healthcare Effectiveness Data and Information Set®, commonly called HEDIS; the Consumer Assessment of Healthcare Providers
and Systems®, or CAHPS, and NCQA Accreditation standards scores.
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