Introduction to Kaiser Permanente - PowerPoint

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					KAISER PERMANENTE

                     Introduction to
                    Kaiser Permanente


                      Robert M. Crane
                               Director,
                         Kaiser Permanente
                      Institute for Health Policy

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KAISER PERMANENTE
                    •   Overview
                    •   Mission
                    •   Structure & Key Features
                    •   History
                    •   Comparison To NHS & US Plans
                    •   Areas Of Focus
                         – Care Management
                         – Information Technology

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                    America’s Largest Non-Profit Health
KAISER PERMANENTE
                              Care Program
                                                Integrated health care
                                                        delivery system
                                                  8.4 million members

                                                   11,000+ physicians

                                                   134,000 employees

                                    8 regions serving 9 states and D.C.

                                     30 hospitals and medical centers
                                                  431 medical offices

                                        $22.5 billion annual revenues
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KAISER PERMANENTE
                              Our Mission

                    To provide high quality, affordable
                    health care services and to improve
                    the health of our members and the
                          communities we serve.




                                                          4
KAISER PERMANENTE              A Prepaid Integrated Delivery System
                                     With Aligned Incentives
                • Social Purpose

                • Quality Driven

                • Shared                     Permanente
                  Accountability for           Medical
                  Program Success              Group
                • Integration along
                  Multiple Dimensions

                • Prevention & Care
                  Management Focus
                                             Health Plan
                                              Members



                                Kaiser                        Kaiser
                              Foundation                    Foundation
                               Hospitals                    Health Plan
                                                                          5
KAISER PERMANENTE
                    Kaiser Permanente Partnership


                                               Kaiser Foundation
                     Permanente                   Health Plan
                    Medical Group                      &
                                                   Hospitals


                            • Common Vision
                            • Exclusivity
                            • Joint Governance & Decision-Making
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KAISER PERMANENTE
                                          A Brief History
                    1933: Dr. Garfield’s 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



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KAISER PERMANENTE
                                         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 4th 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
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KAISER PERMANENTE
                             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.

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KAISER PERMANENTE              America’s Health Dollar, CY 2000
                    Medicare, Medicaid, and SCHIP account for one-third of national health spending.

                                                                             Other Public1
                                                Medicaid and                     12%             Other Private2
                                                  SCHIP                                               6%
                                                   15%




                                CMS
                                                                                                                  Private Insurance
                              Programs
                                33%                                                                                      34%




                                                    Medicare
                                                      17%
                                                                            Out-of-pocket
                                                                                15%

                                                    Total National Health Spending = $1.3 Trillion
                    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.
                                                                                                                                         10
KAISER PERMANENTE
                Health Plan Enrollment by Plan Type, 1988-2001
                                       Over the 1990s, managed care grew dramatically.


                         2001    7%        23%                   48%                     22%


                         2000    8%          29%                   41%                   22%


                         1999     9%         28%                  38%                    25%
                                                                                                           Conventional
                                                                                                           HMO
                         1998        14%         27%                35%                  24%
                                                                                                           PPO
                                                                                                           POS
                         1996          27%                31%                28%           14%


                         1993                46%                   21%             26%          7%


                         1988                          73%                         16%         11%


                                0%         20%          40%          60%           80%           100%


                    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.       11
KAISER PERMANENTE   Northern California Member Demographics
                                     Total Membership: 3.2 Million


                                   Age
                                  12%:
                                  65+
                                          28%: 0-19
                                                                       Coverage
                     25%: 45-64
                                  35%: 20-44



                                                                   87%: Commercial

                                  Ethnicity
                                                        4%: Other
                      66%: Caucasian                      12%: Asian
                                                          7%: African American

                                          11%: Latino
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KAISER PERMANENTE
                            Areas of Focus

                    • Care Management
                    • Information Technology




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KAISER PERMANENTE
                     Costs are not evenly distributed
                    Distribution of Annual Health Care Spending Across Entire US Population
                                                      2000
                      Cost of Healthcare




                                           $25,000                                                   $22,578

                                           $20,000

                                           $15,000

                                           $10,000
                                                                                            $4,919
                                             $5,000                                $1,992
                                                      $14        $224     $695
                                                $0
                                                      1-20%.     21-40%   41-60%   61-80%   81-90%   91-100%




                        Source: Lewis 2000
                                                               Percent of Population
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KAISER PERMANENTE
                       The traditional cost “iceberg”...


                             Employees                                                                              $$$


                                                                                                                    65%
                                      10%

                                      40%                                                                           29%


                                      50%                                                                            5%


                        Distribution of total commercial                                                   Costs associated with each
                                   population                                                                       segment


                                                                                                                                        15
                    Source: 2001 Northern California, Group XYZ Commercial Membership; DxCG methodology.
KAISER PERMANENTE
                        Chronic Illness Drives Medical
                                  Care Costs
                                      People                                                                          $$$


                                         6%         Those w/multiple chronic conditions                              33%

                                                                                                                      31%
                                         21%                   Those w/one chronic condition



                                                                                                                       36%
                                       72%                            Those w/no chronic conditions




                            Segments within the total                                                         Costs associated with each
                                 population                                                                            segment



                    Source: Kaiser Permanente Northern California commercial membership, DxCG methodology, 2001.

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KAISER PERMANENTE
                              10 Clinical Priority Areas
                                                 KP Members
                    Clinical Area             with this Condition
                    Asthma                           141,000
                    Coronary Artery Disease          256,000
                    Depression                      411,000
                    Diabetes                         577,000
                    Heart Failure                      94,000
                    Cancer                      25,000 new cases/yr
                    Chronic Pain                    ~1,000,000
                    Elder Care                       917,000
                    Obesity                       ~25% of adults
                    Self Care                         8.4MM


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KAISER PERMANENTE           Population Management:
                          More than Care & Case Management

                     Targeting      Redesigning             Measurement of
                    Population(s)    Processes           Outcomes & Feedback

                                                     Level 3
                                        Intensive    Highly
                                         or Case     complex
                                       Management    members


                                       Assisted           Level 2
                                      Care or Care        High risk
                                      Management          members



                                       Usual                     Level 1
                                      Care with                       70-80% of a
                                      Support                          CCM pop 18
                     Strategy: Make it easier to do
KAISER PERMANENTE
                     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



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KAISER PERMANENTE
                     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
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                               Kaiser Permanente
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

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KAISER PERMANENTE
                      Our Entire Organization is
                              Impacted
                                     Web Access Portal

                                 Care Delivery Core                   Ancillaries         Health Plan
                          Scope of KP HealthConnect Suite
                         Outpatient                      Inpatient
                                                                                           Membership/
                                                         Scheduling
                         Scheduling                                    Outpatient           Benefits
                                                                       Pharmacy
                                                     Registration
                        Registration
                                                                                              Claims
                                                                            Lab             Processing

                                                          Clinicals


                          Clinicals                                    Radiology/
                                                           Billing      Imaging              Benefits
                                                                                           Accumulation


                                                         Pharmacy
                                                                          Others
                                                                       (immunizations,
                           Billing                                      EKG, dictation)
                                                                                             Pricing
                                                     Emergency
                                                                                             System
                                                     Department




                    Data Warehouse / EDR Enterprise Data Repository
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KAISER PERMANENTE
                      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 (email, web, phone)
                    • Chronic disease management models
                    • Supports for patient self-care
                    • Open access scheduling systems
                    • Enhanced research capability
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KAISER PERMANENTE
                       Kaiser Permanente

                    • People
                    • Understanding
                    • Health




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