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