ehealth Equity An Integrated Delivery System Perspective Brian Raymond, MPH Kaiser Permanente Institute for Health Policy

Transcription

1 ehealth Equity An Integrated Delivery System Perspective Brian Raymond, MPH Kaiser Permanente Institute for Health Policy IOM Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities October 2, 2014 Institute for Health Policy

2 ehealth Equity: An Integrated Delivery System Perspective Skin in the Game A Look at the Research Towards Actionable Strategies Fourth Agenda Fifth Agenda Kaiser Foundation Health Plan, Inc.

3 Kaiser Permanente by the Numbers 8 regions serving 9 states and the District of Columbia More than 9 million members More than 17,000 physicians and 175,000 employees (including 49,000 nurses) 37 hospitals (co-located with medical offices) 618 medical offices and other outpatient facilities 68 years of providing care Kaiser Foundation Health Plan, Inc.

4 ehealth Equity: An Integrated Delivery System Perspective Skin in the Game A Look at the Research Towards Actionable Strategies Fourth Agenda Fifth Agenda Kaiser Foundation Health Plan, Inc.

5 Skin in the Game Kaiser Permanente s Electronic Backbone KP implemented its electronic health record KP HealthConnect between 2004 and 2008 It is the largest civilian health information technology (HIT) system in the US KP s investment in HIT continues At about 6% of revenue Source: Health Information Technology Transformation & Analytics, Terhilda Garrido Kaiser Foundation Health Plan, Inc.

6 Referral & Utilization Management Scope of Kaiser Permanente HealthConnect KP HealthConnect Patient Portal / kp.org Ancillaries Care Delivery Core Health Plan Finance Outpatient Pharmacy Lab Radiology/ Imaging Others (EKG, dictation) Outpatient Scheduling Registration Clinicals Billing Health Info Mgmt Inpatient Clinical documentation ADT CPOE Pharmacy ER Operating Room Billing Membership/ Benefits Claims Processing Benefits Accumulation Pricing System General Ledger Capital Planning Financial Reporting Data Repository Source: Health Information Technology Transformation & Analytics, Terhilda Garrido Kaiser Foundation Health Plan, Inc.

7 Kaiser Permanente HealthConnect Usage 10 Petabytes (PB) 352K visits per day 70K concurrent users 105K MyChart logons/day 99.96% system availability 7M online Rx refills/year 21M online lab results/year 12M secure s/year 36M medical records Source: Health Information Technology Transformation & Analytics, Terhilda Garrido Kaiser Foundation Health Plan, Inc.

8 Redefining Access Empowering Patients Source: Health Information Technology Transformation & Analytics, Terhilda Garrido 2014 Kaiser Foundation Health Plan, Inc. 8 Doris Taylor, a KP member talks about contacting her Doctor from the convenience of her home. She sends a secure message to her doctor via KP HealthConnect. Dr. Liu receives Doris s question and proceeds to reply almost instantaneously. Transforming Access

9 Transforming Primary Care Encounters Care is not just delivered in face-to-face visits now. It is now done on the phone and through secure s. In 2003, there were essentially 0% secure s Now it represents 32% of the primary care patient encounters. 100% 80% 95% 66% 60% 57% 55% 54% 52% KP Program Wide 60% 40% 20% 0% 18% 23% 26% 28% 30% 32% 16% 17% 17% 17% 16% 16% 5% H2013 Source: Health Information Technology Transformation & Analytics, Terhilda Garrido Office Visits Secure Telephone Source: UCDA Core Value Metrics Kaiser Foundation Health Plan, Inc. For internal use only. 9

10 KP mobile ature=c4-overview-vl&list=pl04f0f56c517cd kp.org / mobile 76M visits to kp.org 12M secure s 24M lab views 8M refills 4M patients online! 27% of transactions mobile Source: Health Information Technology Transformation & Analytics, Terhilda Garrido NOTE: Screenshots are mock-ups only. Final designs TBD Kaiser Foundation Health Plan, Inc.

11 Percentile And our quality of care is up 100 th Performance relative to national benchmarks th 75 th th 25 th 10 th 04 Clinical effectiveness composite 04 Diabetes care composite Cardiovascular care composite Hospital clinical effectiveness Hospital mortality 03 Prevention composite 03 Cervical cancer screening 04 Colon cancer screening Best Care for Chronic Conditions Best Hospitals Leading Prevention & Cancer Screening Note: Placement of current status and starting points approximate Source: Health Information Technology Transformation & Analytics, Terhilda Garrido Kaiser Foundation Health Plan, Inc.

12 We re #1 Market-leading Care National Committee for Quality Assurance s Medicare plan rankings, all seven Kaiser Permanente Medicare health plans are in the Top 10 and are all above the 97th percentile Kaiser Permanente Southern California is top-ranked Medicare health plan in the nation for the third year in a row Kaiser Foundation Health Plan, Inc.

13 We Are Not #1 in Health for Everyone, Everywhere Health disparities persist among Kaiser Permanente members Kaiser Foundation Health Plan, Inc.

14 We Are Not #1 in Health for Everyone, Everywhere: Obesity Kaiser Foundation Health Plan, Inc.

15 We Are Not #1 in Health for Everyone, Everywhere: Asthma Kaiser Foundation Health Plan, Inc.

16 We Are Not #1 in Health for Everyone, Everywhere: Diabetes Kaiser Foundation Health Plan, Inc.

17 We Are Not #1 in Health for Everyone, Everywhere: Hypertension Kaiser Foundation Health Plan, Inc.

18 ehealth Should Narrow, Not Widen Health Disparities ehealth benefits may disproportionately accrue to individuals with technology access, resources and skills Potential risks to people without meaningful access to ehealth Kaiser Foundation Health Plan, Inc.

19 ehealth Equity: An Integrated Delivery System Perspective Skin in the Game A Look at the Research Towards Actionable Strategies Fourth Agenda Fifth Agenda Kaiser Foundation Health Plan, Inc.

20 Patient-Provider Improves Quality KP researchers found that secure use by patients was associated with a 2.0 to 6.5% improvement in performance on HEDIS measures, such as glycemic (HbA1c), cholesterol, and blood pressure screening and control. This finding highlight outcome disparities between users and nonusers of secure . Improved quality at Kaiser Permanente through between physicians and patients, YY Zhou, MH Kanter, JJ Wang, T Garrido - Health Affairs, Health Affairs Kaiser Foundation Health Plan, Inc.

21 Disparities in Patient Portal Use: Race/Ethnicity Kaiser Permanente members who are registered for kp.org are more likely to be white (non-hispanic) than those who are not registered Kaiser Foundation Health Plan, Inc.

22 Disparities in Patient Portal Use: Race/Ethnicity African Americans and Latinos were more likely than non-hispanic whites to request a password for the patient portal but never log on Kaiser Foundation Health Plan, Inc.

23 Disparities in Patient Portal Use: Education Kaiser Permanente members with a postgraduate education more frequently registered for access than adults with a high school education or less Kaiser Foundation Health Plan, Inc.

24 ehealth Equity: An Integrated Delivery System Perspective Skin in the Game A Look at the Research Towards Actionable Strategies Fourth Agenda Fifth Agenda Kaiser Foundation Health Plan, Inc.

25 At-Risk Population Segmentation Have Want Don t Want Individuals who currently have information technology access and want to use it for their health Individuals who "want" access to ehealth and could have it if they receive appropriate assistance Individuals who don t want access to ehealth Kaiser Foundation Health Plan, Inc.

26 Have Access Ensure that content and functionality are useful, accessible, and relevant Marketing to ensure that potential ehealth users are aware of the valuable content and functionality available to them Kaiser Foundation Health Plan, Inc.

27 Want Access Increase technology access and skills Offer alternatives to technology provide high quality care and services through low-tech communication channels Kaiser Foundation Health Plan, Inc.

28 Don t Want Access Offer alternatives Marketing to raise awareness of the potential value of ehealth Kaiser Foundation Health Plan, Inc.

29 ehealth Equity An Integrated Delivery System Perspective Follow me on Kaiser Foundation Health Plan, Inc.