Transcript No Slide Title

KAISER PERMANENTE
Introduction to
Kaiser Permanente
Robert M. Crane
Director,
Kaiser Permanente
Institute for Health Policy
1
KAISER PERMANENTE
•
•
•
•
•
•
Overview
Mission
Structure & Key Features
History
Comparison To NHS & US Plans
Areas Of Focus
– Care Management
– Information Technology
2
KAISER PERMANENTE
America’s Largest Non-Profit Health
Care Program
 Integrated health care
delivery system
 8.4 million members
 11,000+ physicians
 134,000 employees
 8 regions serving 9 states and D.C.
 30 hospitals and medical centers
431 medical offices
$22.5 billion annual revenues
3
KAISER PERMANENTE
Our Mission
To provide high quality, affordable
health care services and to improve
the health of our members and the
communities we serve.
4
KAISER PERMANENTE
A Prepaid Integrated Delivery System
With Aligned Incentives
• Social Purpose
• Quality Driven
• Shared
Accountability for
Program Success
Permanente
Medical
Group
• Integration along
Multiple Dimensions
• Prevention & Care
Management Focus
Health Plan
Members
Kaiser
Foundation
Hospitals
Kaiser
Foundation
Health Plan
5
KAISER PERMANENTE
Kaiser Permanente Partnership
Permanente
Medical Group
Kaiser Foundation
Health Plan
&
Hospitals
• Common Vision
• Exclusivity
• Joint Governance & Decision-Making
6
KAISER PERMANENTE
A Brief History
1933: Dr. Garfield’s prepaid health
plan in the California desert
1938: 6,500 workers at the Grand
Coulee Dam, Washington
1942: Kaiser shipyards in
Richmond,CA; Vancouver, WA;
and steel mill in Fontana, CA
1945: Membership opened to the
public
1948: The Permanente Medical Group
founded
1955: The Tahoe agreement, roles of
PMGs and KFHP set
7
KAISER PERMANENTE
A Brief History
1958: Hawaii added as 4th region
1997: The Labor Management Partnership
(LMP) was forged and ratified by 26
AFL-CIO unions. It is the largest and
most complex health care partnership
in the United States - both
operationally and in scope.
1969: Colorado and Ohio regions
added
1980: Mid-Atlantic region added
through acquisition
1985: Georgia region started
1998 Care Management Institute started
1999: Commitment to implement common
automated medical record HealthConnect
8
KAISER PERMANENTE
Comparing KP and NHS
• In many ways KP is like the NHS, providing a similar
range of services for a population equivalent to that
of a small country.
• KP is roughly the same age as the NHS.
• Unlike the NHS, Permanente physicians cannot work
outside the system.
Feachem, et. al., BMJ January 19, 2002
• Unlike the NHS, KP does not serve the entire
population of a geographic area but rather operates
in a competitive environment.
9
KAISER PERMANENTE
America’s Health Dollar, CY 2000
Medicare, Medicaid, and SCHIP account for one-third of national health spending.
Medicaid and
SCHIP
15%
Other Public1
12%
Other Private2
6%
CMS
Programs
33%
Private Insurance
34%
Medicare
17%
Out-of-pocket
15%
Total National Health Spending = $1.3 Trillion
Other public includes programs such as workers’ compensation, public health activity, Department of Defense, Department
of Veterans Affairs, Indian Health Service, and State and local hospital subsidies and school health.
2 Other private includes industrial in-plant, privately funded construction, and non-patient revenues, including philanthropy.
1
Note: Numbers shown may not sum due to rounding.
Source: CMS, Office of the Actuary, National Health Statistics Group.
10
KAISER PERMANENTE
Health Plan Enrollment by Plan Type, 1988-2001
Over the 1990s, managed care grew dramatically.
2001
7%
23%
48%
2000
8%
29%
1999
9%
28%
22%
41%
22%
38%
25%
Conventional
1998
14%
27%
35%
HMO
24%
PPO
POS
1996
27%
1993
31%
46%
1988
28%
21%
73%
0%
20%
40%
60%
14%
26%
7%
16%
11%
80%
100%
Source: Employer Health Benefits, 2001 Annual Survey, The Kaiser Family Foundation and Health Research and
Educational Trust. Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.
11
KAISER PERMANENTE
Northern California Member Demographics
Total Membership: 3.2 Million
Age
12%:
65+
25%: 45-64
Coverage
28%: 0-19
35%: 20-44
87%: Commercial
Ethnicity
4%: Other
12%: Asian
66%: Caucasian
7%: African American
11%: Latino
12
KAISER PERMANENTE
Areas of Focus
• Care Management
• Information Technology
13
Distribution of Annual Health Care Spending Across Entire US Population
2000
Cost of Healthcare
KAISER PERMANENTE
Costs are not evenly distributed
$22,578
$25,000
$20,000
$15,000
$10,000
$4,919
$5,000
$14
$224
$695
1-20%.
21-40%
41-60%
$1,992
$0
61-80%
81-90%
91-100%
Source: Lewis 2000
Percent of Population
14
KAISER PERMANENTE
The traditional cost “iceberg”...
Employees
$$$
65%
10%
40%
29%
50%
5%
Distribution of total commercial
population
Source: 2001 Northern California, Group XYZ Commercial Membership; DxCG methodology.
Costs associated with each
segment
15
KAISER PERMANENTE
Chronic Illness Drives Medical
Care Costs
People
6%
$$$
Those w/multiple chronic conditions
21%
72%
Segments within the total
population
33%
31%
Those w/one chronic condition
36%
Those w/no chronic conditions
Costs associated with each
segment
Source: Kaiser Permanente Northern California commercial membership, DxCG methodology, 2001.
16
KAISER PERMANENTE
10 Clinical Priority Areas
Clinical Area
KP Members
with this Condition
Asthma
141,000
Coronary Artery Disease
256,000
Depression
Diabetes
Heart Failure
Cancer
Chronic Pain
Elder Care
Obesity
Self Care
411,000
577,000
94,000
25,000 new cases/yr
~1,000,000
917,000
~25% of adults
8.4MM
17
KAISER PERMANENTE
Population Management:
More than Care & Case Management
Targeting
Population(s)
Redesigning
Processes
Measurement of
Outcomes & Feedback
Level 3
Intensive
or Case
Management
Assisted
Care or Care
Management
Usual
Care with
Support
Highly
complex
members
Level 2
High risk
members
Level 1
70-80% of a
CCM pop
18
KAISER PERMANENTE
Strategy: Make it easier to do
the right thing...
• Identify the right thing
– Define evidence-based medicine
– Identify successful practices
– Leverage measurement to guide performance improvement
• Make the right thing easier
–
–
–
–
Embed guidelines within systems to support practice
Implement effective and innovative models of care
Support teams of professionals to care for members
Leverage technology to support population-based care
19
KAISER PERMANENTE
Information Technology
• Diverse current capacities
•
•
•
•
Disease registries
Notes and prompts
Order entry
Results reporting
• New system of computerized support
tools
• Opportunity to re-engineer care
20
KAISER PERMANENTE
Kaiser Permanente
HealthConnect
• More than just an electronic medical record
• A sophisticated information management and
delivery system
• A program-wide system that will integrate the
clinical record with appointments, registration and
billing
• A complete healthcare business system that will
enhance the quality of patient care and support
the KP Promise
21
KAISER PERMANENTE
Our Entire Organization is
Impacted
Web Access Portal
Care Delivery Core
Ancillaries
Health Plan
Scope of KP HealthConnect Suite
Outpatient
Scheduling
Inpatient
Scheduling
Outpatient
Pharmacy
Membership/
Benefits
Registration
Registration
Lab
Claims
Processing
Clinicals
Clinicals
Billing
Pharmacy
Radiology/
Imaging
Others
(immunizations,
EKG, dictation)
Billing
Emergency
Department
Benefits
Accumulation
Pricing
System
Data Warehouse / EDR Enterprise Data Repository
22
KAISER PERMANENTE
KP HealthConnect Delivers
• Approaches to advanced care planning (simple
registries, reminder systems, protocols)
• Coordination across sites of care
(patient is identified throughout system, locations)
• Shared decision-making tools
• Multiple points of contact (email, web, phone)
• Chronic disease management models
• Supports for patient self-care
• Open access scheduling systems
• Enhanced research capability
23
KAISER PERMANENTE
Kaiser Permanente
• People
• Understanding
• Health
24