Transcript Document

Stepping Up to Total Health
together
WE BUILD A BRIGHTER FUTURE
Union Delegates Conference 2012
March 24, 2012
Raymond J. Baxter, PhD
Senior Vice President
Community Benefit, Research and Health Policy
Kaiser Permanente’s History
Our Mission for Generations:
“To provide high quality, affordable health care,
and to improve the health of our members and the communities we serve”
Grand Coulee Dam - 1942
Page 2
We’re #1…Market-leading Prevention
HEDIS Measures 2011
KP REGIONAL MARKET RANKING
NCAL
SCAL
Breast Cancer Screening
1
1*
1
Childhood Immunization Status – Combo 2 & 3
1*
Chlamydia Screening in Women - Total
HI
NW
CO
GA
MAS
OH
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1*
1
1
1
1
1
1
1
1
Appropriate Treatment for Children w/URI
1*
1
1
1
1
1
1
1
12
Adult BMI Assessment
1*
1
1
1
1
1
1
1
Weight Assessment for Children –
BMI Percentile
1*
1
1
1
1
1
1
1
Comprehensive Diabetes Care –
Medical Attention for Nephropathy
1*
1
1
1
1
1
1
1
*NCQA market ranking based on state boundary, and not KP regional market. SCAL and NCAL ranked first within each of
its KP regional markets, but second in NCQA state market only to each other.
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We’re #1…Market-leading Care
NCQA ranking of 341 Medicare health plans in US (2011)
KP Medicare Ranking
National1
State
Northern California
1
1
Southern California
2
2
Colorado
3
1
Georgia
31
1
Hawaii
7
1
Mid Atlantic2
17
1
Northwest3
4
1
Ohio
19
1
KEY:
1\ Medicare ranking out of 341 ranked health plans
2\ Mid Atlantic ranked #1 for Medicare in VA, DC, and MD
3\ Northwest ranked #1 in OR and WA
4\ Second only to the other KP plan in California
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4
Pills, Knives, Devices and Gene Therapy Will Not Be Enough
Page 5
We Must Address Health At All Levels
Deploying Kaiser Permanente Assets for Total Health
Physical and Mental Health Care
Clinical Prevention
Research
Community
Health
Initiatives
Environmental
Stewardship
Health Education
Individual /
Family
1
Home / School /
Worksite
Neighborhood /
Community
Society
Access to Social
and Economical
Supports
Walking
Promotion
Worksite
Wellness
Public Policy
Public Education
Page 6
Many Factors Shape Health
 Health is driven by multiple factors that are intricately linked – of which medical
care is one component.
Drivers of Health
Personal
Behaviors
40%
Family History
and Genetics
30%
Environmental
and Social
Factors
20%
Page 7
Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993
10%
Medical
Care
Behaviors Shape Health
Actual Causes of Death in the U.S. in 1990 and 2000
Number (and %)
1990*
Number (and %)
2000
Tobacco
400,000 (19%)
435,000 (18.1%)
Poor diet and physical inactivity
300,000 (14%)
400,000 (16.6%)
Alcohol consumption
100,000 (5%)
85,000 (3.5%)
Microbial agents
90,000 (4%)
75,000 (3.1%)
Toxic agents
60,000 (3%)
55,000 (2.3%)
Motor vehicle
25,000 (1%)
43,000 (1.8%)
Firearms
35,000 (2%)
29,000 (1.2%)
Sexual behavior
30,000 (1%)
20,000 (0.8%)
Illicit drug use
20,000 (<1%)
17,000 (0/7%)
1,060,000 (50%)
1,159.000 (48.2%)
Actual Cause
Total
*Data are from McGinnis and Foege. Percentages are for all deaths.
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We Have to Disrupt Current Defaults…
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What We’re Up Against
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What We’re Up Against
Change in price of items since 1978, relative to overall inflation, as measured by the
Consumer Price Index. The price of carbonated drinks, for example, has fallen 34 percent
relative to all other prices.
Source: Leonhardt, 2010
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What We’re Up Against
Page 12
What We’re Up Against
Probability of Obesity
0.4
White Male
White Female
Black Male
Black Female
0.3
0.2
0.1
0
0
100
200
300
Minutes Spent in Car Per Day
Slide courtesy of Richard Jackson, MD
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400
500
Interventions: Individual
We know what to do…
Screen
Advise
Assist
Refer
… we have the tools…
… and we need to do it with each
and every member.
Page 14
Interventions: Individual/Family
Exercise As Vital Sign, Exercise Rx
Tools, Tips, Motivation and Support
Smith, John W
•
Page 15
Recommend at least 150 minutes
of moderate to strenuous exercise
per week.
•
Office-based
•
Direct-to-member
•
Online tools
•
Cooking tips
Interventions: Activity
Evidence of Short and Long Term Benefits
Aerobic exercise
helps strengthen
the heart, lungs,
and muscles
Reduces risk of
oseteoporosis
and broken bones
Helps people with
diabetes to control
their blood sugar
Raises HDL
Reduces the pain
and swelling
from arthritis
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Gain 1.3-1.5
healthy years of
life
Improves mood
and energy
Regular walking
can prevent misery
of colds
Interventions: Institutional
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KP Farmers’ Markets
Cafeteria menu labeling, KP Healthy Picks
KP facilities as community assets
Environmental stewardship
Supplier diversity initiative
Page 17
Interventions: Employers
We have begun to offer a portfolio of services that can help KP customers,
prospects and other organizations improve the health of their workforce.
Analytics & Reporting
• HealthMedia Reporting
• Exercise Pgm.
Reporting
• Rewards reports
• Kp.org activity reports
Page 18
Communications
• Standard & customizable
print/web communications
• HealthWorks Workbook
Lifestyle Telephonic
Health Coaching
• Inbound coaching
Interventions: Community Health
Healthcare
• BMI as a vital sign
• Breastfeeding promotion
• Hospital cafeterias
Healthcare
Schools
Schools
• Cafeteria reforms
• PE standards, after school programs
• Joint Use Agreements
• Safe routes to school
Worksites
• Stairwell prompts
• Lactation support
• Worksite wellness programs
Neighborhoods
• Parks, trails and other active public spaces
• General Plan amendments
• Corner store conversion efforts
• Farmers markets and community gardens
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Neighborhoods
Worksites
Interventions: Getting to Scale
www.communitycommons.org
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Big Opportunities Exist for the U.S. and Kaiser Permanente
Less Than Half of the U.S. Population Meets Healthy
People 2020 Objectives for Diet and Exercise
Kaiser Permanente Members With 150
Minutes or More of Exercise Per Week(1)
100%
80%
KP target = 100%
78.4%
60%
41.0%
40%
Current regional
36.0% average = 43%
20%
0%
Age 12-17
Age 18-64
(1) Southern California
Source: BRFSS, 2007
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Age 65+
An Integrated Approach to Diseases and Risk Factors
4 Diseases, 4 Risk Factors*  4 Kaiser Permanente Actions
Encourage Groups
Support Individuals
Cardiovascula
r Disease
Cancer
Diabetes
Change Communities
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Chronic
Respiratory
Disease
*Aligns with World Health Organization’s framework for
monitoring non-communicable diseases
Track Outcomes
A Total Health Portfolio
Total Health will require a coordinated set of activities, focusing on some key initial areas
while developing core capabilities and enhancing efforts on work underway.
Total Health
Focus Areas
Core Capabilities
“Fundamentals”
Focus as first and
relatively complete
demonstrations of Total
Health, done
everywhere in KP
Essential components
needed to realize
Total Health
Healthy Schools
Workforce Wellness
 KP Integrated Care Model
 Behavior Change strategies
 Member Assistance Program
 Effective Communications
Applications of
Total Health
Work underway but
Total Health lens can
help deepen the work
and re-double our
efforts
 Every Body/KP Walk!
 The Weight of the Nation
 HEAL/obesity prevention
and treatment
 Hypertension control
 Disparities elimination
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Why Schools?
Benefit to KP
Page 24
•High penetration in school districts
•Big opportunity for membership growth
•Strong relationships with schools.
•School staff are extremely loyal to KP
•Schools represent nearly 10% of KP’s membership (or ~900,000 members)
Benefit to
School
•Early evidence of population health impacts through healthy school interventions
•Improved academic performance and fewer disciplinary problems
•Increased student attendance and school revenue
•Impacts on staff healthcare costs & presenteeism
Benefit to
Family /
Community
•Healthy kids are the best hope for society – they are the future workforce and role
models
• Decreases in absenteeism and improved productivity for parents
Vision: Schools Served by KP are the Healthiest Schools in America
What makes a healthy school?
•Multi-component interventions
•Multi-stakeholder engagement
•Consultative support and technical assistance
Health
Education
Mental
Health &
Social
Services
Parent &
Community
Involvement
Physical
Activity
Healthy
School*
Nutrition:
School Meals
& Food
Policy,
Systems &
School
Environment
Before &
After School
Programs
Employee
Wellness
Page 25
* Draws from CDC Coordinated School Health, Alliance Healthy Schools Framework & WELCOA (Wellness Council of America)
KP Is Already Delivering on Many Total Health Components for
Schools, Their Staff and Students
• Comprehensive services for KP members
• Forty CHI sites integrate student health components at a local level
• Grantmaking, technical assistance and advocacy support district- and state- level change
• Employee wellness offerings are available to schools across KP through HealthWorks (~250 CA school districts)
Individual / Family: Member-Focused Assets across the Health Continuum
Promoting Health
•
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Anticipating Health Risks
•
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Preventive care: EVS & BMI and counseling
E-mail providers
Health education & promotion including classes for families
Online resources & telephonic coaching
Well child visits and sports physicials
Menu Labeling
Managing Chronic Conditions
Immunizations
Self-care tools & resources
Best-practice care
Proactive outreach
Referrals without pre-approval
Registry data tracks risk factors
School: Student-Focused Assets
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Educational theatre
KP volunteers
Mentorship programs
School-based health
centers
Outreach / enrollment for
subsidized insurance
TV turnoff
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Worksite: Staff -Focused Assets
SPARK
PE interventions
Every Body Walk!
School gardens
Farm to school
Fitnessgram
PlayWorks
Individual /
Family
Home / School /
1
Worksite
Neighborhood /
Community
Society
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Consultative support to
create a wellness
strategy
Biometric Screenings
Health promotion classes
Incentive programs
Healthy lifestyle programs
Neighborhood & Community & School: Policy / Environmental Assets
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Cafeteria / vending
reforms
Universal breakfast
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PE standards
Safe routes to school
Joint Use Agreements
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Photovoice
School wellness
councils

Eligibility
determination for
federal nutrition
programs
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FruitGuys
Healthy Picks
Toolkits
Every Body Walk!
Thrive Across
America
10,000 Steps
Healthy Schools: Tiered Model for High Reach and High Impact
Offer a “KP Healthy Schools” tiered product available to all schools within Kaiser Permanente’s
existing footprint. Leverage and integrate existing KP assets including HealthWorks,
Community Benefit and the delivery system alongside a national partner.
* Lower
Reach /
Higher
Intensity
• Leverage additional offerings to targeted
schools including: medical center
Tier 3
volunteers, school-based health centers,
Unique
ETP, CHI grants, KP mentor / apprentice
Enhancements programs, mental health / school climate
and more.
Tier 2
Intensive
Consultation &
Capacity Building
* Higher
Reach /
Lower
Intensity
Page 27
Tier 1
Ready-to-use Tools &
Resources
Launch Fall 2013
• Field-based consultants build
schools’ capacity to identify
needs and address priorities via Launch Fall 2013
consultation, training, linkages
to TA providers, KP assets and
more.
• Connect schools in
KP’s footprint to online
resources, train-thetrainer webinars, peer Launch Fall 2012
learning opportunities
and Schools Walk!
Program.
KP’s Origins: The Health of the Workforce
Our Mission of Generations:
“To improve the health of our members and the communities we serve”
Page 28
Total Health Aspiration: KP Workforce is the Healthiest in Healthcare
Workforce Vision
KP workforce is productive, healthy, thriving, leading
satisfied lives and fulfilled careers, committed to KP
vision, highly skilled and engaged in learning and
improvement, creative, flexible, positive, resilient
Page 29
Healthy Hospital Choices: Recommendations and
Approaches from an Expert Panel
Food/Beverage
Physical Activity
• Health sector and public health have an opportunity to address the nation’s chronic disease burden and
health care costs by promoting healthy hospital food environments.
• Healthy food is to be defined not only by nutrition standards but also by an economically &
environmentally sustainable food system.
• Current food environment measurement tools should be further adapted for hospitals.
• Food policies should cover all venues, including cafeterias, vending machines, snack carts and gift shops.
• Promote trails, public spaces and use of hospital facilities for physical activity opportunities.
• Create policies that promote access to facilities and time for physical activity during all hospital shifts.
• Connect physical activity strategies to emerging evidence and national efforts to combat obesity.
Breastfeeding
• Breastfeeding is encouraged by most major health agencies.
• Hospitals are a unique setting in that they can support breastfeeding for employees, patients and visitors.
• Hospitals should support breastfeeding by providing break rooms and time for expressing breast milk for
employees and, where possible, for visitors.
Tobacco Cessation &
Control
• Customary hospital practices and resistance from employees and patients who smoke may pose barriers
to efforts to implement tobacco-free hospital campus policies, but these barriers can be overcome with
careful planning and preparation.
• A tobacco control model can incorporate Joint Commission performance measures and achieve a high
level of compliance to effective policies and practices.
• Coverage of tobacco cessation treatments varies by health insurance plan and availability of services
varies across communities.
Dissemination &
Surveillance
Page 30
• Successful strategies to improve hospital environments include identifying partners, such as public
health, with clearly defined wellness goals, tailoring messages and garnering executive endorsement.
• Healthcare providers can be engaged as effective advocates to disseminate and make changes to nutrition
and physical activity environments within their own institutions.
• Demonstrating linkages to other hospital priorities and creating a recognition system is a key element.
• A national assessment tool and indicators for large scale success will help in disseminating best
practices.
Workforce Wellness: Where to Start?
Healthy
Eating
Healthy Physical
Environment
Healthy Activity
at Work
Page 31
Workforce Wellness: “Champion” Level
Fundamentals Required for Transformation to Champion Level
Senior
Leadership
Operations
Leadership
Self
Leadership
Reward
Behavior
Quality
Assurance
Create the Vision
Align Workplace
with Vision
Create Winners
Reinforce
Culture of Health
Outcomes
Drive Strategy
•Commitment to
healthy culture
•Connect vision to
business strategy
•Engage leadership
in vision
•Leaders are held
accountable
Page 32
•Engage everyone
•Help employees
not get worse
•Brand health
management
strategies
•Help healthy
employees stay
healthy
•Integrate policies
into culture
•Provide
improvement &
maintenance
strategies
•Reward
champions
•Integrate all
resources
• Set incentives
for healthy
choices
•Measure progress
towards goals in
first 4 pillars
•Reinforce at
every touch point
•Strategic, Systemic,
Systematic,
Sustainable
Source: Dee Edington, Zero Trends: Health as a Serious Economic Strategy, Health Management Research
Center, University of Michigan, 2009
Note: HERO, WELCOA, and NBGH models contain same fundamentals
We Have to Engage People in the Solutions
 Kaiser Permanente has assumed a leadership role in promoting the
power of walking
 Collaborative development of two dynamic online programs:
 For Kaiser Permanente Employees: KP Walk!
 Get Involved: www.KPWalk.com
 For All Americans: Every Body Walk!
 Get Involved: www.EverybodyWalk.org
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We Have Become the Benchmark
May 2012
Page 34
The Road Ahead is Challenging…But We Can Find A Way
Page 35