Presentation on theme: "Introduction to Kaiser Permanente"— Presentation transcript:
1 Introduction to Kaiser Permanente Robert M. CraneDirector,Kaiser PermanenteInstitute for Health Policy
2 Structure & Key Features History Comparison To NHS & US Plans OverviewMissionStructure & Key FeaturesHistoryComparison To NHS & US PlansAreas Of FocusCare ManagementInformation Technology
3 America’s Largest Non-Profit Health Care Program Integrated health care delivery system30 hospitals and medical centers431 medical offices$22.5 billion annual revenues8.4 million members134,000 employees8 regions serving 9 states and D.C.11,000+ physicians
4 Our MissionTo provide high quality, affordable health care services and to improve the health of our members and the communities we serve.
5 A Prepaid Integrated Delivery System With Aligned Incentives Social PurposeQuality DrivenShared Accountability for Program SuccessIntegration along Multiple DimensionsPrevention & Care Management FocusPermanenteMedicalGroupHealth PlanMembersKaiserFoundationHospitalsKaiserFoundationHealth Plan
6 Kaiser Permanente Partnership Kaiser FoundationHealth Plan&HospitalsPermanenteMedical GroupCommon VisionExclusivityJoint Governance & Decision-Making
7 A Brief History1933: Dr. Garfield’s prepaid health plan in the California desert1938: 6,500 workers at the Grand Coulee Dam, Washington1942: Kaiser shipyards in Richmond,CA; Vancouver, WA; and steel mill in Fontana, CA1945: Membership opened to the public1948: The Permanente Medical Group founded1955: The Tahoe agreement, roles of PMGs and KFHP set
8 A Brief History1997: 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 4th region1969: Colorado and Ohio regions added1980: Mid-Atlantic region added through acquisition1985: Georgia region started1998 Care Management Institute started1999: Commitment to implement common automated medical record -HealthConnect
9 Comparing KP and NHSIn 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, 2002Unlike the NHS, KP does not serve the entire population of a geographic area but rather operates in a competitive environment.
10 America’s Health Dollar, CY 2000 Medicare, Medicaid, and SCHIP account for one-third of national health spending.CMSPrograms33%Total National Health Spending = $1.3 Trillion1 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.
11 Health Plan Enrollment by Plan Type, 1988-2001 Over the 1990s, managed care grew dramatically.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.
12 Northern California Member Demographics Total Membership: 3.2 Million Age12%:65+Coverage28%: 0-1925%: 45-642%:Medi-Cal11%:Medicare35%: 20-4487%: CommercialEthnicity4%: Other66%: Caucasian12%: Asian7%: African American11%: Latino
13 Areas of FocusCare ManagementInformation Technology
14 Costs are not evenly distributed Distribution of Annual Health Care Spending Across Entire US Population 2000Cost of HealthcareSource: Lewis 2000Percent of Population
15 The traditional cost “iceberg”... Employees$$$65%10%40%29%5%50%Distribution of total commercial populationCosts associated with each segmentSource: Northern California, Group XYZ Commercial Membership; DxCG methodology.
16 Chronic Illness Drives Medical Care Costs People$$$6%Those w/multiple chronic conditions33%31%21%Those w/one chronic condition36%72%Those w/no chronic conditionsCosts associated with each segmentSegments within the total populationSource: Kaiser Permanente Northern California commercial membership, DxCG methodology, 2001.
17 10 Clinical Priority Areas KP Members Clinical Area with this ConditionAsthma 141,000Coronary Artery Disease 256,000Depres sion ,000Diabetes 577,000Heart Failure 94,000Cancer 25,000 new cases/yrChronic Pain ~1,000,000Elder Care 917,000Obesity ~25% of adultsSelf Care 8.4MM
18 Population Management: More than Care & Case Management Targeting Population(s)Redesigning ProcessesMeasurement of Outcomes & FeedbackIntensiveor Case ManagementAssisted Care or Care ManagementUsual Care with SupportLevel 170-80% of a CCM popLevel 2High risk membersLevel 3Highly complex members
19 Strategy: Make it easier to do the right thing... Identify the right thingDefine evidence-based medicineIdentify successful practicesLeverage measurement to guide performance improvementMake the right thing easierEmbed guidelines within systems to support practiceImplement effective and innovative models of careSupport teams of professionals to care for membersLeverage technology to support population-based care
20 Information Technology Diverse current capacitiesDisease registriesNotes and promptsOrder entryResults reportingNew system of computerized support toolsOpportunity to re-engineer care
21 Kaiser Permanente HealthConnect More than just an electronic medical recordA sophisticated information management and delivery systemA program-wide system that will integrate the clinical record with appointments, registration and billingA complete healthcare business system that will enhance the quality of patient care and support the KP Promise
22 Our Entire Organization is Impacted Web Access PortalCare Delivery CoreAncillariesHealth PlanScope of KP HealthConnect SuiteOutpatientInpatientMembership/ BenefitsSchedulingSchedulingOutpatientPharmacyRegistrationRegistrationLabClaims ProcessingClinicalsClinicalsRadiology/ ImagingBillingBenefits AccumulationPharmacyOthers(immunizations,EKG, dictation)BillingPricingSystemEmergencyDepartmentData Warehouse / EDR Enterprise Data Repository
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 toolsMultiple points of contact ( , web, phone)Chronic disease management modelsSupports for patient self-careOpen access scheduling systemsEnhanced research capability