B j i K Ch MD MPHBenjamin K. Chu, MD, MPHPresidentKaiser Permanente Southern California

Great Gains in Quality of Care and Patient Safety:

Th K i P E iThe Kaiser Permanente Experience

The “triple aim”: A blueprint for a more satisfying f t ?future?

• Improving the health of our populationp g p p

• Improving the care experience• Improving the care experience

• Focus on value and cost efficiency

Founded in 1945, Kaiser Permanente is one of the nation’s largest nonprofit health plans serving more than 8.8 million members in eight regions across the country

A Snapshot ofKaiser Permanente

Kaiser Permanente’s capitated payment model places equal emphasis on keeping people healthy Kaiser Permanente

• 8.8 million members• 35 hospitals• 431 medical offices

places equal emphasis on keeping people healthy and caring for members when they are ill.

• 15,000 physicians• 167,000 employees• $45 billion annual revenue• $4 billion health information$4 billion health information

technology investment• 60 years of providing care• Focus on prevention of

ill d diillness and disease• Focus on improving

community health helps our members and patientsmembers and patients

Kaiser Permanente’s Integrated System Connects Health Plan and Health Care ServicesSystem Connects Health Plan and Health Care Services

• Kaiser Permanente hasHEALTH PLAN

MEMBERS

• Kaiser Permanente has integrated finance and care delivery services

• This creates the ability to allocate resources where

KAISERKAISER

allocate resources where needed to achieve the best health outcomes for the patient

• Kaiser Permanente’s capitated t d l lKAISER KAISER

FOUNDATIONFOUNDATIONHEALTH PLANHEALTH PLAN

payment model places as much emphasis on keeping people health as it does on caring for members when they

illKAISER

FOUNDATIONHOSPITALS

Southern California PERMANENTE

MEDICAL GROUP

are ill.

Key Drivers of Quality and Service Improvement

• Actionable, real time information through electronic tools

• Absolute transparency of results – a mirror on organizational and individual mirror on organizational and individual performance

• Benchmarks • Benchmarks • Cultural change efforts

Kaiser Permanente Clinical Information Systems provide better patient management using evidence-based medicine

LabsLabs RegistriesRisk stratification of

HospitalHospital

PharmacyPharmacy

populationIdentify subgroups needing specific carePatient management

Clinical Clinical InformationInformation

Outpatient AppointmentsOutpatient Appointments

O t ti tO t ti t

Patient management toolsTargeted panel listsPrompts, reminders for

SystemsSystemsOutpatient EncounterOutpatient Encounter

MembershipMembership

o pts, e de s ocliniciansLetters and automated telephone outreach to members

Emergency DepartmentEmergency Department

I i iI i i

membersMonitoring and process improvement measures and reports

ImmunizationsImmunizations Targeted health education and self-care support

Kaiser Permanente’s Registry for Chronic Diseases and Panel Management can be used for physician panel managementg p y p gCare team members can access registry and panel management tools to help address care gaps

Proactive encounters at every point of contact have revolutionized how Kaiser Permanente provides total health health Pre-Encounter (proactive identification)

Office Encounter• Vital sign collection

and documentation

Post Encounter• Immediate: after-

visit summary,

Back Office Support

• Lettersidentification)• Identify missing labs,

screening procedures, access management, kp.org

and documentation• Identify and flag alerts

for provider• Room and prepare

patient for necessary

visit summary, after care instructions, follow-up appointments,

Letters• E-mail• Inbox

Managementmanagement, kp.org status, etc.

• Provide member instructions before visit

patient for necessary exams

• Pre-encounter follow up

appointments, Health Education materials, how to access kp.org

• Future: follow-upvisit• Contact member and

document encounter in Kaiser Permanente

Future: follow up contact and appointments per provider

• All staff have responsibility for patients’ total health.N t ll ti t th i i h i i

Permanente HealthConnect™

• Not all patients see their primary care physician.• Every office encounter has been redesigned to optimize each patient contact. • Areas of need are identified and acted on.

Outcomes in Kaiser Permanente Southern California for better total health

Using its information technology tools, Kaiser Permanente Southern California has improved almost all major measures including breast cervical and colorectalimproved almost all major measures, including breast, cervical, and colorectal screenings; controlling high blood pressure, and osteoporosis management

90%

70%

80%

60%Breast Cancer Screening (52-69)Cerv ical Cancer Screening

40%

50%Cerv ical Cancer ScreeningColorectal Cancer ScreeningControlling High Blood Pressure (Ages 18-85)Osteoporosis Management in Women Who Had a Fracture

YE 2005 YE 2006 YE 2007 YE 2008 YE 2009 YE 2010

Patient safety measures have improved steadily over the last few years and outperform some national measures

Hospital-Acquired Pressure Ulcers TJC Core Measures

6%

7%

8%

90%

95%

100%

2%

3%

4%

5%

6%

70%

75%

80%

85%

90%

0%

1%

Q1

07

Q2

07

Q3

07

Q4

07

Q1

08

Q2

08

Q3

08

Q4

08

Q1

09

Q2

09

Q3

09

Q4

09

Q1

10

Q2

10

Q3

10

Q4

10

Q1

11

KPSC HAPUs, All Stages CalNOC Average

60%

65%

1Q07

2Q07

3Q07

4Q07

1Q08

2Q08

3Q08

4Q08

1Q09

2Q09

3Q09

4Q09

1Q10

2Q10

3Q10

4Q10

AMI Bundle HF Bundle CAP Composite SCIP Composite

1.0

1.2

1.4

1.6

0.70

0.75

0.80Blood Stream Infections Mortality Rates

0.0

0.2

0.4

0.6

0.8

07

2 07

3 07

4 07 08

2 08

3 08

4 08 09

2 09

3 09

4 09 10

2 10

3 10

Q 1

0

Q 1

1 0.50

0.55

0.60

0.65

Q06

Q06

Q07

Q07

Q07

Q07

Q08

Q08

Q08

Q08

Q09

Q09

Q09

Q09

Q10

Q10

Q10

Q10

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

4Q 1Q

KPSC ICU BSI Rate NNIS BSI Rate Average

3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q

US Medicare Overall KPSC

Hospital infection control improvements

3 0

3.5

4.0

ter d

ays

25.0

30.0

nt d

ays

KPSC Hospital Acquired C-diff Rate

Community Acquired Rate

Urinary Tract Infections – ICU Hospital v. Community Acquired Clostridium - Difficile

1.0

1.5

2.0

2.5

3.0

rate

s pe

r 100

0 ca

thet

KPSC CAUTI Rate10.0

15.0

20.0

Rate

per

10,

000

patie

n Community Acquired Rate

> >

0.0

0.5

1Q 10 2Q 10 3Q 10 4Q 10 1Q 11

CAU

TI

National Adult ICU Benchmark

0.0

5.0

1Q 08 2Q 08 3Q 08 4Q 08 1Q 09 2Q 09 3Q 09 4Q 09 1Q 10 2Q 10 3Q 10 4Q 10

C-D

iff

Blood Stream Infections – Med/Surg Blood Stream Infections – NICU

0.8

1

1.2

1.4

000

line

days

4.0

5.0

6.0

7.0

00 li

ne d

ays

>

g Blood Stream Infections NICU

0

0.2

0.4

0.6

BS

I rat

es p

er 1

0

KPSC Non-ICU CLABSI rate

National Benchmark - Non ICU med/surg

0.0

1.0

2.0

3.0

1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q

BSI

rate

per

1,0

0

KPSC BSI-NICU

NHSN BSI NICU Benchmark

> >

1Q 10 2Q 10 3Q 10 4Q 10 1Q 11 1Q 07

2Q 07

3Q 07

4Q 07

1Q 08

2Q 08

3Q 08

4Q 08

1Q 09

2Q 09

3Q 09

4Q 09

1Q 10

2Q 10

3Q 10

4Q 10

1Q 11

Clinical strategic goals benefits achieved (lives saved) (lives saved)

2004 – October 2010Metric Increase Savings Per DecadeMetric Increase Savings Per Decade

Cholesterol Control 22.5% 1807 LivesBlood Pressure Control 41.8% 5739 LivesHbA1C < 9.0 12.5% 1182 LivesSmoking cessation 17.0% 1011 LivesBreast Cancer Screening 11.5% 575 Lives

Cervical cancer screening 5.8% 58 lives

Colon cancer screening 29.8% 4724 lives

Total: 15 096 livesTotal: 15,096 lives

HCAHPS inpatient service scores are amenable to similar interventions

Rate Hospital (9-10) – All Inpatient CombinedMarch 2007 vs. May 2011

HCAHPS R t h it l (9 10) All IP C bi d

10th 25th 50th 60th 75th 85th 90th

BM: CMS Nationa l Benchmark Based on

HCAHPS: Rate hospital (9-10) - All IP Combined

HCAHPS: Rate hospital (9-10) Month of May '11All IP Combined

55.0 61.0 66.0 68.0 0.0 72.0 75.0 78.0

SCAL Facility

March 2007 May 2011 75th 85th 90th

Irvine NA 83 7 83 710th 25th 50th

BM: CMS Nationa l Benchmark Based on Reporting Period 2009 Q1 - 2009 Q4

Irvine NA 83.7 83.7Downey 56.0 83.4 56.0 83.4 Panorama City 42.4 79.9 42.4 79.9 Los Angeles 50.3 77.2 50.3 77.2 Baldwin Park 61.6 74.9 61.3 74.9 Anaheim 57.4 73.3 57.4 73.3 Woodland Hills 50.3 72.8 50.3 72.8West LA 53.7 72.5 53.7 72.5 Riverside 39.5 70.6 39.5 70.6 South Bay 54.3 69.5 54.3 69.5 Moreno Valley NA 69.4 69.4 San Diego 44.2 68.1 44.2 68.1 Fontana 51.0 65.9 51.0 65.9

KP Southern Re 50.4 73.9 50.4 73.9

Outcomes: Hip fractures decreased by almost 40% d t ti due to proactive measures

Hip fractures in older l d t

37% total reduction in hip fractures in older

women

women lead to many complications including:• Lack of mobility• Inability to provide self-care

• Expensive nursing homecare

• Death