Presentation on theme: "KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy."— Presentation transcript:
KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy
KAISER PERMANENTE 2 Overview Mission Structure & Key Features History Comparison To NHS & US Plans Areas Of Focus –Care Management –Information Technology
KAISER PERMANENTE 3 Americas Largest Non-Profit Health Care Program Integrated health care delivery system 30 hospitals and medical centers 431 medical offices $22.5 billion annual revenues 8.4 million members 134,000 employees 8 regions serving 9 states and D.C. 11,000+ physicians
KAISER PERMANENTE 4 Our Mission To provide high quality, affordable health care services and to improve the health of our members and the communities we serve.
KAISER PERMANENTE 5 A Prepaid Integrated Delivery System With Aligned Incentives Kaiser Foundation Hospitals Permanente Medical Group Kaiser Foundation Health Plan Members Social Purpose Quality Driven Shared Accountability for Program Success Integration along Multiple Dimensions Prevention & Care Management Focus
KAISER PERMANENTE 6 Kaiser Permanente Partnership Permanente Medical Group Common Vision Exclusivity Joint Governance & Decision-Making Kaiser Foundation Health Plan & Hospitals
KAISER PERMANENTE 7 A Brief History 1933: Dr. Garfields prepaid health plan in the California desert 1938: 6,500 workers at the Grand Coulee Dam, Washington 1942: Kaiser shipyards in Richmond,CA; Vancouver, WA; and steel mill in Fontana, CA 1945: Membership opened to the public 1948: The Permanente Medical Group founded 1955: The Tahoe agreement, roles of PMGs and KFHP set
KAISER PERMANENTE 8 A Brief History 1997: The Labor Management Partnership (LMP) was forged and ratified by 26 AFL-CIO unions. It is the largest and most complex health care partnership in the United States - both operationally and in scope. 1958: Hawaii added as 4 th region 1969: Colorado and Ohio regions added 1980: Mid-Atlantic region added through acquisition 1985: Georgia region started 1998 Care Management Institute started 1999: Commitment to implement common automated medical record - HealthConnect
KAISER PERMANENTE 9 Comparing KP and NHS In many ways KP is like the NHS, providing a similar range of services for a population equivalent to that of a small country. KP is roughly the same age as the NHS. Unlike the NHS, Permanente physicians cannot work outside the system. Feachem, et. al., BMJ January 19, 2002 Unlike the NHS, KP does not serve the entire population of a geographic area but rather operates in a competitive environment.
KAISER PERMANENTE 10 1 Other public includes programs such as workers compensation, public health activity, Department of Defense, Department of Veterans Affairs, Indian Health Service, and State and local hospital subsidies and school health. 2 Other private includes industrial in-plant, privately funded construction, and non-patient revenues, including philanthropy. Note: Numbers shown may not sum due to rounding. Source: CMS, Office of the Actuary, National Health Statistics Group. CMS Programs 33% Medicare, Medicaid, and SCHIP account for one-third of national health spending. Total National Health Spending = $1.3 Trillion Americas Health Dollar, CY 2000
KAISER PERMANENTE 11 Health Plan Enrollment by Plan Type, Source: Employer Health Benefits, 2001 Annual Survey, The Kaiser Family Foundation and Health Research and Educational Trust. Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook. Over the 1990s, managed care grew dramatically.
KAISER PERMANENTE 12 Northern California Member Demographics Total Membership: 3.2 Million 28%: 0-19 %: 35%: %: %: Age 11%: Medicare 2%: Medi-Cal 87%: Commercial Coverage 4%: Other 12%: Asian 7%: African American 11%: Latino 66%: Caucasian Ethnicity
KAISER PERMANENTE 13 Areas of Focus Care Management Information Technology
KAISER PERMANENTE 14 Distribution of Annual Health Care Spending Across Entire US Population 2000 Source: Lewis 2000 Percent of Population Cost of Healthcare Costs are not evenly distributed
KAISER PERMANENTE 15 The traditional cost iceberg... Distribution of total commercial population Costs associated with each segment Employees $$$ 10% 40% 50% 5% 29% 65% Source: 2001 Northern California, Group XYZ Commercial Membership; DxCG methodology.
KAISER PERMANENTE 16 Segments within the total population Costs associated with each segment Those w/no chronic conditions Those w/one chronic condition Those w/multiple chronic conditions People $$$ 72% 21% 6% 36% 31% 33% Source: Kaiser Permanente Northern California commercial membership, DxCG methodology, Chronic Illness Drives Medical Care Costs
KAISER PERMANENTE Clinical Priority Areas KP Members Clinical Area with this Condition Asthma 141,000 Coronary Artery Disease256,000 Depression 411,000 Diabetes577,000 Heart Failure 94,000 Cancer25,000 new cases/yr Chronic Pain~1,000,000 Elder Care917,000 Obesity~25% of adults Self Care8.4MM
KAISER PERMANENTE 18 Population Management: More than Care & Case Management Intensive or Case Management Assisted Care or Care Management Usual Care with Support Level % of a CCM pop Level 2 High risk members Level 3 Highly complex members Targeting Population(s) Redesigning Processes Measurement of Outcomes & Feedback
KAISER PERMANENTE 19 Strategy: Make it easier to do the right thing... Identify the right thing –Define evidence-based medicine –Identify successful practices –Leverage measurement to guide performance improvement Make the right thing easier –Embed guidelines within systems to support practice –Implement effective and innovative models of care –Support teams of professionals to care for members –Leverage technology to support population-based care
KAISER PERMANENTE 20 Information Technology Diverse current capacities Disease registries Notes and prompts Order entry Results reporting New system of computerized support tools Opportunity to re-engineer care
KAISER PERMANENTE 21 Kaiser Permanente HealthConnect More than just an electronic medical record A sophisticated information management and delivery system A program-wide system that will integrate the clinical record with appointments, registration and billing A complete healthcare business system that will enhance the quality of patient care and support the KP Promise
KAISER PERMANENTE 22 Our Entire Organization is Impacted Lab Radiology/ Imaging Others (immunizations, EKG, dictation) Outpatient Pharmacy Care Delivery Core Health Plan Claims Processing Membership/ Benefits Benefits Accumulation Pricing System Outpatient Clinicals Scheduling Registration Inpatient Scheduling Billing Pharmacy Registration Emergency Department Clinicals Web Access Portal Data Warehouse / EDR Enterprise Data Repository Scope of KP HealthConnect Suite Billing Ancillaries
KAISER PERMANENTE 23 KP HealthConnect Delivers Approaches to advanced care planning (simple registries, reminder systems, protocols) Coordination across sites of care (patient is identified throughout system, locations) Shared decision-making tools Multiple points of contact ( , web, phone) Chronic disease management models Supports for patient self-care Open access scheduling systems Enhanced research capability
KAISER PERMANENTE 24 Kaiser Permanente People Understanding Health