The Kaiser Permanente Experience A Focus on Chronic Illness and Health Promotion and Wellness...
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Transcript of The Kaiser Permanente Experience A Focus on Chronic Illness and Health Promotion and Wellness...
The Kaiser Permanente ExperienceA Focus on Chronic Illness and Health Promotion and Wellness Initiatives
Louise Liang, MDSenior Consultant, Kaiser PermanenteThe Global Knowledge Exchange NetworkApril 2009
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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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3 © Copyright Kaiser Permanente
About Kaiser Permanente
• Integrated health caredelivery system
• 8.7 million members
• 165,000 employees
• Serving 9 states and the District of Columbia
• 14,000 physicians
• Nation’s largest nonprofit health plan
• 36 hospitals and medical centers
• 416 medical offices
• $37.8 billion annual revenues (2007)
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Ages0-19
28.7% Ages45-6428% Ages
20-44
33.2%
Ages65+
11.1%
Membership by Coverage Type
85% Commercial
Medicare10.%
Special Programs
3%
Medicaid
2%
African American9.6%
Asian8.6%
Membership by Ethnicity Type
28.3%Hispanic
46.2%
Caucasian
7.3% Other
Who Are KP Members?
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A FOCUS ON CHRONIC ILLNESS INITIATIVES
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The Care Management Institute1997 - 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 Evidence-based medicine Measurement Successful practices
• Make the right things easier 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.
Keeping patients at the center Harnessing technology Integrating capabilities across Kaiser Permanente Applying evidence Measuring results Spreading successful practices
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Lab
Radiology/Imaging
Others (immunizations, EKG, dictation)
Outpatient Pharmacy
Health Plan
ClaimsProcessing
Membership/Benefits
Benefits Accumulation
PricingSystem
Web Access Portal
Data Warehouse / EDR Enterprise Data Repository
Ancillaries
Ref
erra
l & U
tiliz
atio
n M
anag
emen
t
Finance
Capital Planning
General Ledger
FinancialReporting
Care Delivery Core
Outpatient Inpatient
Scope of KP HealthConnect Suite
Scheduling
Registration
Clinicals
Billing
Admission, Discharge
and Transfer
Health InformationManagement
Clinicals
Billing
Pharmacy
EmergencyDepartment
Operating Room
Health InformationManagement
Kaiser Permanente HealthConnect™
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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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10 © Copyright Kaiser Permanente
Kaiser Permanente HealthConnect™
• Integrating health care across the continuum 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
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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 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”
• 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
By Catherine Chen, Terhilda Garrido, Don Chock, Grant Okawa, and Louise Liang, MD. Published in Health Affairs, March 2009.
12 © 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
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 toolA primary care physician’s patients and their care gaps
Execution
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Whole panel viewsVitals signs for the primary care team
Execution
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Round 2: Specialty Panels
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Improves preparationPrevents late referral
Improves appropriate referrals
Benefits of proactive specialty care
Slows progression to ESRN
Late Referral (<4 Months Prior to ESRD)
32%
19%16%
11%
KPHI 2004 KPHI 2005 KPHI 2006 KPHI 2007
Fistula Present, Start of Hemodialysis
29%
39%44%
48%
2004 2005 2006 2007
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A FOCUS ON WELLNESS INITIATIVES
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Disease Registries
Risk Stratification
Patient management tools
Targeted panel lists
Inreach – Clinical prompts & reminders
Outreach- Letters & Calls
Continuous process improvement
LabsLabs
InpatientInpatient
OutpatientOutpatient
EmergencyEmergency
PharmacyPharmacy
ImagingImaging
ImmunizationImmunization
KP HealthConnect™
• Secure Web-Based• Universal Access• Real Time• Linked to delivery system• Not claims-based
MembershipMembership
Financial and Benefits
Financial and Benefits
kp.org and My Health Manager
Population Management Tool
Integrated Clinical Information Systems
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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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Employers
• Productivity
• Health of workforce
• Presenteeism
• Spending
Members
• Weight
• Smoking
• Stress
• Pain
• Health
• Nutrition habits
• Management of diabetes
Positive Outcomes from Healthy Lifestyle Programs
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Detailed information on thousands of drugs
Search directory of over 2,250 classes available across CA
Over 20 Featured Health Topics from Asthma to Women’s Health
In-depth information on over 4,000 topics
Links to health calculators, complimentary care services, health videos, audio programs, recipes, and much more
Much of the content and resources is available in Spanish
Additional Online Resources
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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