Improving Health Care Quality

Through Integrated TeamsWoHIT Barcelona March 17, 2010

Hal WolfSr. VP COO

The Permanente Federation, LLC

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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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About Kaiser Permanente

* 2008 revenues

• 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

International Rankings and National

Health Expenditures

Closing

the Gap

US data collated by

Professor Bill

Runciman,

President, Australian

Patient Safety

Foundation from

McGlynn et al; NEJM

2006 Vol 348;

p2635-45

© 2008 Map of Medicine Ltd and Zynx Health Inc.

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IOM’s 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

“Organizations will need to negotiate successfully six major challenges.”

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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

Growing Consensus About

Ideal Care

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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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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.

The Physician Role Changes

The Traditional Model

of Care

New Model Elements

One Patient at a time

Only Know about patients who

appear in your office

No use of IT

Limited use of extenders

Accountability for

panel/population

Transparency

Use of EMR, registries,

internet

Moving care out of the Dr. office

Panel Management

Population Care Management. Born from the development of Registries.

02000+

DCCVD

HTN

$ 6 million/year

15% Panel 85%

Standard Patient Categorizing

Primary Secondary Acute Chronic

Complex

Standard

Known

Dx

Sort

Dx

Patient

Standard

Process

Sort

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

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Key Success Factors

Clear, agreed upon, mission

Strong, dedicated leadership

Aligned structure and incentives

Integrated information technology and performance improvement

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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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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

It’s Not the Box

OO + NT = COO

It’s Not the Box

OO + NT = COOOld organization + New Technology = Costly Old Organization