Transcript Document

The Kaiser Permanente Experience
A Focus on Chronic Illness and Health Promotion and Wellness
Initiatives
Louise Liang, MD
Senior Consultant, Kaiser Permanente
The Global Knowledge Exchange Network
April 2009
Kaiser Permanente as a leader
Opened to the
public in 1945,
Kaiser Permanente
is the largest
nonprofit, integrated
health care delivery
system in the
United States.
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About Kaiser Permanente
• Nation’s largest nonprofit health plan
• Integrated health care
delivery system
• 8.7 million members
• 14,000 physicians
• 165,000 employees
• Serving 9 states and the District of
Columbia
• 36 hospitals and medical centers
• 416 medical offices
• $37.8 billion annual revenues (2007)
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© Copyright Kaiser Permanente
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Who Are KP Members?
Membership by Age
Ages
65+
11.1%
Ages
45-64
28%
Membership by Coverage Type
Ages
0-19
28.7%
85% Commercial
Ages
20-44
33.2%
Membership by Ethnicity Type
Asian
African American 8.6%
9.6%
Medicaid
2%
Hispanic
28.3%
Special
Programs
3%
7.3% Other
Caucasian
46.2%
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A FOCUS ON CHRONIC ILLNESS
INITIATIVES
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The Care Management Institute
1997 - 2005
• Developed in 1997 as a national KP organization jointly funded
and managed by the Health Plan and the Permanente Medical
Groups.
• Mission: “Making the right thing easier to do.”
• Identify the right things
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Evidence-based medicine
Measurement
Successful practices
• Make the right things easier
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Focus on the delivery system
Technology to support effective work
Networks of individuals and groups
Initial focus was in the development of “world class” clinical practice guidelines for the
organization and provide a laboratory for interesting clinical delivery problems.
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The Care Management Institute
2005 +
• CMI promotes superior care for KP system-wide, improving
care all the way to the member. We inform and enable KP in
setting performance improvement priorities for population care,
and we support Regions in achieving transformative health care
through our integrated capabilities of care delivery
improvement, analytics, and evaluation.
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Keeping patients at the center
Harnessing technology
Integrating capabilities across Kaiser Permanente
Applying evidence
Measuring results
Spreading successful practices
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Kaiser Permanente HealthConnect™
Web Access Portal
Ancillaries
Care Delivery Core
Health Plan
Finance
Outpatient
Pharmacy
Outpatient
Inpatient
Scheduling
Admission, Discharge
and Transfer
Health Information
Management
Lab
Registration
Clinicals
Clinicals
Radiology/
Imaging
Billing
Emergency
Department
Operating Room
Others
(immunizations,
EKG, dictation)
Pharmacy
Health Information
Management
Billing
Referral & Utilization Management
Scope of KP HealthConnect Suite
Membership/
Benefits
General
Ledger
Claims
Processing
Capital
Planning
Benefits
Accumulation
Financial
Reporting
Pricing
System
Data Warehouse / EDR Enterprise Data Repository
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KP’s IT Infrastructure
• Data in our Electronic Medical Record enables:
 Direct patient care, documentation, and
communication
 Communication with our Members
 Population Management
 Decision Support
 Panel Management and Performance Reporting
 Automated outreach
 Health Information On-Line targeted to patient health
history and preferences
 Biomedical Device Integration
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Kaiser Permanente HealthConnect™
• Integrating health care across the continuum
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Inpatient & outpatient clinical care: Documentation,
Ordering, Decision Support
Hospital & outpatient practice management: Billing,
Scheduling, Registration, ADT (admission, discharge
and transfer)
Ancillary systems: Pharmacy, Labs, Radiology, etc.
Online access to personal health record: My health
manager at kp.org
© Copyright Kaiser Permanente
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Kaiser Permanente HealthConnect™
by the Numbers
• All 8.7 million members have the benefit of a
complete or partial KP HealthConnect record
• Outpatient EMR available to all care teams
• 23 hospitals deployed end-to-end with complete KP
HealthConnect suite
• Almost 3 million members actively using My Health
Manager on kp.org
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Universal adoption by providers
6.1 million e-mails sent to providers in 2008
5.6 million prescriptions refilled online in 2008
16.8 million lab results viewed online in 2008
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“Transforming & Streamlining Modalities
of Care”
By Catherine Chen, Terhilda Garrido, Don Chock, Grant Okawa, and Louise Liang, MD.
Published in Health Affairs, March 2009.
• Deployed KP HealthConnect (EHR) and My Health
Manager (PHR) in Hawaii region in 2005. Impact
between 2004-2007.
• Annual office visit rate -26.2%
primary care
-25.3%
specialty care -21.5%
• Scheduled telephone visits + 8 fold
• Secure e-mail messaging +6 fold to 51,000 in 2007
• Total patient contacts +8.3 percent
• Quality and satisfaction maintained or slightly
improved
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© Copyright Kaiser Permanente
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KP Clinical Content
• Access to library of KP knowledge and best
medical practices at the point of care
• Tools and templates that facilitate the delivery of
evidence-based medicine
• Dynamic decision-support tools that enhance
quality and patient safety
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Drug-Drug Interactions Alerts
Drug Allergy Alerts
Best Practice Alerts
Health Maintenance Reminders
Alternative Order and Medication Alerts
• Patient education and
tools to support self-care
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Total Panel Ownership with
KP HealthConnect
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Panel support tool
A primary care physician’s patients and their care gaps
Execution
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Whole panel views
Vitals signs for the primary care team
Execution
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Round 2: Specialty Panels
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Benefits of proactive specialty care
Improves preparation
Prevents late referral
Fistula Present, Start of Hemodialysis
Late Referral (<4 Months Prior to ESRD)
32%
44%
48%
39%
19%
29%
16%
11%
KPHI 2004
KPHI 2005
KPHI 2006
KPHI 2007
Improves appropriate referrals
2004
2005
2006
2007
Slows progression to ESRN
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A FOCUS ON WELLNESS
INITIATIVES
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Integrated Clinical
Information Systems
Population
Management Tool
Disease Registries
Labs
Inpatient
Outpatient
Emergency
Pharmacy
Imaging
KP
HealthConnect™
• Secure Web-Based
• Universal Access
• Real Time
• Linked to delivery
system
• Not claims-based
Financial and
Benefits
Patient management
tools
Targeted panel lists
Inreach – Clinical
prompts & reminders
Outreach- Letters &
Calls
Immunization
Membership
Risk Stratification
kp.org and
My Health Manager
Continuous process
improvement
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My Health Manager
• Web-based options are playing
a larger role in doctor-patient
interaction
• Patients who use secure e-mail
were 7 to 10 percent less likely
to schedule an office visit, and
make about 14 percent fewer
phone contacts than those not
using online services
• E-mail is more convenient and
efficient for both the physician
and patient for non-urgent
concerns.
Source: American Journal of Managed Care
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My Health Manager – Member Benefits
• Secure view of EHR:
 View lab results, immunizations, allergies, past office visits
• Interact with care team:
 E-mail my doctor, complete a HRA
• Convenient transactions:
 Refill prescriptions, manage appointments,
act for a family member
• Educational opportunities:
 Links to health & drug encyclopedias, online
behavior change programs
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KP.ORG
KP HealthConnect allows
members to send secure
email, review lab results,
medication lists, and other
personal medical information
via KP.org using a secure
and password-protected
Internet connection. At any
time, day or night, members
can schedule or cancel
appointments, pay bills, request
medication refills, and ask for
referrals. Members’ personal
health information will be
seamlessly integrated into
KP.org to help them better
understand the care they're
receiving - and build a stronger
relationship with their KP
providers.
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Total Health Assessment
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Positive Outcomes from Healthy Lifestyle
Programs
Members
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Weight
Smoking
Stress
Pain
• Health
• Nutrition habits
• Management of
diabetes
Employers
• Productivity
• Health of
workforce
• Presenteeism
• Spending
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Additional Online Resources
Over 20 Featured Health Topics
from Asthma to Women’s Health
In-depth information on over
4,000 topics
Detailed information
on thousands of drugs
Links to health calculators,
complimentary care services,
health videos, audio programs,
recipes, and much more
Search directory of
over 2,250 classes
available across CA
Much of the content and resources
is available in Spanish
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What KP will Deliver Tomorrow?
• Employers
 Additional tools & resources to
promote employee health and
productivity
• Members
 New features, tools, and content
added to My Health Manager
 Streamlined access, personalized
views
• KP HealthConnect™
 Extend inpatient capabilities
 Leverage integration and information
for complete care and population
management
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