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Introduction to Kaiser Permanente. Robert M. Crane Director, Kaiser Permanente Institute for Health Policy. Overview Mission Structure & Key Features History Comparison To NHS & US Plans Areas Of Focus Care Management Information Technology. 8.4 million members.

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introduction to kaiser permanente

Introduction to Kaiser Permanente

Robert M. Crane

Director,

Kaiser Permanente

Institute for Health Policy

slide2
Overview
  • Mission
  • Structure & Key Features
  • History
  • Comparison To NHS & US Plans
  • Areas Of Focus
    • Care Management
    • Information Technology
slide3

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

America’s Largest Non-Profit Health Care Program

  • Integrated health care delivery system
our mission
Our Mission

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

slide5

A Prepaid Integrated Delivery System

With Aligned Incentives

  • Social Purpose
  • Quality Driven
  • Shared Accountability for Program Success
  • Integration along Multiple Dimensions
  • Prevention & Care Management Focus

Permanente

Medical

Group

Health Plan

Members

Kaiser

Foundation

Hospitals

Kaiser

Foundation

Health Plan

kaiser permanente partnership
Kaiser Permanente Partnership

Kaiser Foundation

Health Plan

&

Hospitals

Permanente

Medical Group

  • Common Vision
  • Exclusivity
  • Joint Governance & Decision-Making
a brief history
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

a brief history8
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

comparing kp and nhs
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.
slide10

America’s Health Dollar, CY 2000

Medicare, Medicaid, and SCHIP account for one-third of national health spending.

CMS

Programs

33%

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.

slide11

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.

slide12

Northern California Member DemographicsTotal Membership: 3.2 Million

Age

12%:

65+

Coverage

28%: 0-19

25%: 45-64

2%:

Medi-Cal

11%:

Medicare

35%: 20-44

87%: Commercial

Ethnicity

4%: Other

12%: Asian

66%: Caucasian

7%: African American

11%: Latino

areas of focus
Areas of Focus
  • Care Management
  • Information Technology
slide14

Costs are not evenly distributed

Distribution of Annual Health Care Spending Across Entire US Population 2000

Cost of Healthcare

Source: Lewis 2000

Percent of Population

slide15

The traditional cost “iceberg”...

$$$

Employees

65%

10%

29%

40%

5%

50%

Distribution of total commercial population

Costs associated with each segment

Source: 2001 Northern California, Group XYZ Commercial Membership; DxCG methodology.

slide16

Chronic Illness Drives Medical Care Costs

People

$$$

Those w/multiple chronic conditions

33%

6%

31%

21%

Those w/one chronic condition

36%

Those w/no chronic conditions

72%

Costs associated with each segment

Segments within the total population

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

slide17

10 Clinical Priority Areas

KP MembersClinical Areawith this Condition

Asthma 141,000

Coronary Artery Disease 256,000

Depres sion 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

slide18

Level 3

Highly complex members

Intensive

or Case Management

Level 2

High risk members

Assisted Care or Care Management

Usual Care with Support

Level 1

70-80% of a CCM pop

Population Management:More than Care & Case Management

Redesigning Processes

Targeting Population(s)

Measurement of Outcomes & Feedback

slide19

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
information technology
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
slide21

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
slide22

Membership/Benefits

Scheduling

Scheduling

Outpatient

Pharmacy

Registration

Registration

ClaimsProcessing

Lab

Clinicals

Radiology/Imaging

Benefits Accumulation

Billing

Pharmacy

Others

(immunizations,

EKG, dictation)

Pricing

System

Emergency

Department

Data Warehouse / EDR Enterprise Data Repository

Our Entire Organization is Impacted

Web Access Portal

Ancillaries

Health Plan

Care Delivery Core

Scope of KP HealthConnect Suite

Outpatient

Inpatient

Clinicals

Billing

slide23

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
kaiser permanente
Kaiser Permanente
  • People
  • Understanding
  • Health