Kaiser Permanente Total Health: A Bold Goal East Midlands, National Health Service November 2013

1. Kaiser Permanente Total Health: A Bold GoalEast Midlands, National Health ServiceNovember 2013 Alide Chase, SVP Medicare Clinical Operations and Population Care

2. Kaiser Permanente Strategic Vision To be a Leader inTotal Health by making lives better. Total Health is a state of complete physical, mental and social well-being for all people. We are committed to helping our members, our workforce, their families, and our communities achieve Total Health through the services we provide and by promoting clinical, behavioral, environmental, and social actions that improve the health of all people.

3. Video “Stay Longer”

4. Total Health: Support Our Members Through All Stages of Life TotalHealth Staying Healthy Returning to Health Living Well withChronic Conditions Healthy Aging

5. Big Concepts • Shift from Disease Management to Population Care • Embracing Total Health • Care Transformation • Patient/Family Activation • Social and Community Activation

6. Drivers of Health

7. Many Factors Shape Health Health is driven by multiple factors that are intricately linked – of which medical care is one component. Drivers of Health Personal Behaviors 40% Family History and Genetics 30% Environmental and Social Factors 20% 10% Medical Care Source: McGinnis et al, Health Affairs, 2002

8. …we are developing a more sophisticated analytical model to deepen our understanding of effective interventions. Clinical Care and Prevention • Access to care • Quality of care • Clinic-community integration Health Outcomes And Wellbeing Social & Economic Factors • Education • Employment • Income • Family & social support • Community safety • Culture • Physiology • Disease and injury • Health and function • Wellbeing Health Behaviors & Other Individual Factors • Diet & activity • Tobacco use • Alcohol use • Unsafe sex • Genetics • Spirituality • Resilience • Activation Programs and Policies Physical Environments • Built environment • Food environment • Media/information environment • Environmental quality Adapted from County Health Rankings, 2010 and M. Stiefel, 2012. Draft: 9/15/2012 Settings: Home Workplace School Neighborhood Clinic Virtual

9. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 1999 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10. Rate of Obesity According to BMI Source: Sturm 2003

11. The Problem of Extreme Obesity in Children 9.4% 9.1% 7.3% 6.5% 4.5% 4.2% 3.3% 2.2% Koebnick C. (July 2010). Prevalence of Extreme Obesity in a Multiethnic Cohort of Children and Adolescents, Journal of Pediatrics, V 57.

12. What does it mean? The Epidemic of Overweight and Obesity “I think we’re looking at a first generation of children who may live less long than their parents as a result of the consequences of overweight and type 2 diabetes.” www.discoveryhealthCME.com, N Engl J Med Vol. 352(11) March 2005, pp. 1138-1145

13. What We’re Up Against

14. What We’re Up Against

16. Excess weight increases risk of…. Idiopathic intracranial hypertension Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Phlebitis venous stasis Skin Plantar Fasciitis

17. Why Total Health? Integrated Approach to Risk Factors and Disease Diseases + Risk Factors Kaiser Permanente Actions  Encourage Groups Cardiovascular Disease  Support Individuals Economics RISK FACTORS Unhealthy Diet Inactivity TobaccoHarmful use of Alcohol Cancer Diabetes Physical  Change Communities • Track Outcomes Chronic RespiratoryDisease Social

18. We Must Address Health At All Levels Deploying Kaiser Permanente Assets for Total Health Physical and Mental Health Care“Body, Mind and Spirit” Health Education Clinical Prevention 1 Walking Promotion Research Individual / Family and Technology Access to Social and Economical Supports Home / School /Worksite Community Health Initiatives Worksite/Workforce Wellness Neighborhood / Community Environmental Stewardship Society Public Policy Public Information

19. Disrupt Current Defaults … Confidential – For Internal Use Only

20. … to Create Optimal Defaults for Total Health 20

21. Kaiser Permanente’s Approach to Total Health

22. A Strategic Approach to Delivering Total Health Total Health will require a coordinated set of activities, focusing on some key initial areas while developing core capabilities and enhancing efforts on work underway. Total HealthFocus Areas Focus as first and relatively complete demonstrations of Total Health, done everywhere in KP Core Capabilities“Fundamentals” Essential components needed to realize Total Health Work underway butTotal Health lens can help deepen the work and re-double our efforts Applications of Total Health

23. Focus on Schools andKaiser Permanente’s Workforce

24. Healthy Schools: Our Aim Key Strategies

25. Healthy Schools: Why Schools? Benefit to School Benefit to Family/Community Benefit to KP

26. * Lower Reach / Higher Intensity Healthy Schools: Organizing an Approach to Schools * Higher Reach / Lower Intensity

27. Tools for Schools and Kids

28. Workforce Wellness: Becoming a Leader Create a work culture and environment that supports Kaiser Permanente’s workforce in making healthy lifestyle choices and to become the healthiest workforce in health care.

29. Workforce Wellness: Where to Start Healthy Eating Healthy Physical Environment Healthy Activity at Work

30. Getting our Workforce Walking

31. Website that’s About Your Goals and Needs • Member selects goals • Member decides what’s important • Creates direct virtual connection to provider and resources

32. Applying Total Health Behavior Change Strategies CLINICAL EXECUTION ONLINE ENGAGEMENT ENVIRONMENTAL AND COMMUNITY STRATEGIES

33. We Have the Tools – Exercise As Vital Sign Smith, John W Confidential – For Internal Use Only

34. Hopp2IT - Pilot WHAT IT DOES: Hopp2IT empowers individuals to be healthier with the use of incentives and gamification. Includes a social media component to partner up with individuals and teams for “Healthy Opportunities” in a fun and easy way. Mobile app began piloting internally within IT workforce in January 2013.

35. Areas of strongest focus for the future

36. Total Health is a Campaign

37. And we are not alone…. Institute of Medicine: Accelerating Progress in Obesity Prevention (May 2012)

38. Total Health Dashboard Alcohol/Substances Healthy Eating No measure – placeholder only TBD- Placeholder for Alcohol/Substances Metric Overall Functional Status and Well Being Social Health Behavioral Health TBD - Placeholder for Depression Metric TBD – Coordinate with Community Benefits TBD – Placeholder for metric

39. The road ahead is challenging…but we can find a way.