1. CATHERINE ALBIN PHD MD REGIONAL PICU DIRECTOR KAISER PERMANENTE NORTHERN CALIFORNIA 2015 VPS USER CONFERENCE MARCH 24 2015 Alignment of a Health Care System through VPS

2. Kaiser Permanente Conceived as a pre paid health care system by Dr Sidney Garfield during the depression Henry J Kaiser (industrialist) during WWII Primarily is a Health Plan (not for profit), but has fully integrated system  The Permanente Medical Group (partnership, outpatient)  Kaiser Foundation Hospitals (nurses, hospital management and capital projects) Evolution to include relationships with Medicare, Medicaid (MediCal/CCS), ACA exchanges California, Hawaii, Pacific Northwest, Colorado, Mid Atlantic, Georgia

3. Northern California Recent consolidation of pediatric units into Hubs 3 PICUs strategically located in Northern California Located in close proximity to University based Pediatric programs Each structured differently, very different budgets and staffing practices. Each regionally funded, option of local medical center to provide additional support

5. California PICU options Role of CCS (California Children’s Services) Requirements for a CCS accredited PICU are the same regardless of size, affiliation Option to be a community level PICU Requires VPS data submission: quality measure California Title 22 regulations: very non specific  Age of patients  Competency of staff  Nursing ratio  Physical environment

6. Aligning Health Care Goals, Needs and Budgets Share models of care: MD staffing, call structures, allied support Data on common diagnoses  Demographics  Acuity scores  Efficiency  Outcomes  Planned vs unplanned Analyze the outcomes and “raise the bar” for each unit with regional integration Transport concerns Telemedicine Budgets!!!!!!!

7. Uncovering Myths Length of stay predictions based on diagnosis or acuity Staffing models, closed units, nursing assignment Role of consultants Step down functions of other units Attending expectations, continuity, call structures Budget!

8. California Proposal SB586: KIDS Integrated Delivery System Maintains the structure of CCS accreditation  Special care centers, specialists, paneled physicians  Increases age limits to 26 if previously followed by CCS Requires coordination through a children’s hospital with a governance accepting responsibility for achieving measured quality improvements and reductions in the rate of spending growth VPS in this vision Comparison of units, outcomes and acuities