Kaiser Permanente: Integration, Innovation, and Information Systems in Health Care

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1 Kaiser Permanente: Integration, Innovation, and Information Systems in Health Care October 2012 Molly Porter, Director Kaiser Permanente International kp.org/international Copyright 2012 Kaiser Permanente

2 Key Topics Kaiser Permanente as a Leader Physician Performance Our Strategy, Mission, and Model Kaiser Permanente HealthConnect and online features (to include demo) Copyright 2012 Kaiser Permanente 2

3 How Americans Access Health Care Employers Medicare Medicaid & CHIP Individuals Uninsured 161M Employees and Dependents Access Health Care Through Employer Coverage 42M Pensioners (over 65 Years) and Disabled Access Health Care Through Medicare 42M Low-Income Americans Access Health Care Through Medicaid and 5M Near-Poor Through the Children s Health Insurance Program (CHIP) 11M Americans Access Health Care Through Their Own Insurance Policy 50M Americans Have No Coverage and Access Care Through Clinics and Emergency Departments Copyright 2012 Kaiser Permanente 3

4 Health Care in the U.S. Health Status Although we lead the world in per-capita health spending, and excel in certain areas such as cancer treatment and new technology, the U.S. does not have better overall population health than other industrialized countries that spend less than we do. The U.S. ranks 34 th in the world in life expectancy, at 78 years. Two-thirds of Americans are overweight or obese. (34% obese; 34% overweight but not obese Centers for Disease Control and Prevention) Half of Americans do not receive recommended preventive care, which includes vaccinations, cancer screenings, and blood pressure checks but Kaiser Permanente does much better than this! Copyright 2012 Kaiser Permanente 4

5 Performance Gets You the Podium if we could actually get our health care system across the board to hit the efficiency levels of a Kaiser Permanente we actually would have solved our problems. President Barack Obama TIME Magazine July 29, 2009 Copyright 2012 Kaiser Permanente 5

6 Cost-Effective, High-Quality Care at KP The 2012 Aon Hewitt reports showed that Kaiser Permanente: Is 16% more cost-effective than the all-plan average in the markets it serves, making it the most cost-effective plan overall. Is 139% better in clinical quality than the all-plan average in the markets it serves, making it first in clinical quality in all eight regions. Copyright 2012 Kaiser Permanente 6

7 Expanding our Presence in Washington, D.C. centerfortotalhealth.org Capitol Hill Medical Center opened January 2011 Center for Total Health opened April 2011 Copyright 2012 Kaiser Permanente 7

8 Kaiser Permanente as a Leader Opened to the public in 1945, Kaiser Permanente is recognized as one of America s leading health care providers and nonprofit health plans. We are committed to helping shape the future of health care. Copyright 2012 Kaiser Permanente 8

9 Our Numbers (as of 12/31/2011) 8 regions serving 9 states and the District of Columbia 9 million members 17,000 physicians; 173,000 employees (including 48,000 nurses) 37 hospitals (co-located with medical offices) 611 medical offices and other outpatient facilities 67 years of providing care Copyright 2012 Kaiser Permanente 9

10 Our Markets and Membership: as of January 2012 Northwest Region Portland, OR Vancouver, WA 480,171 members Northern California Region 3,392,347 members Colorado Region 536,094 members Ohio Region 96,957 members Mid-Atlantic Region Washington, DC Maryland Virginia 489,069 members Southern California Region 3,566,857 members Georgia Region 238,736 members Hawaii Region 227,030 members Copyright 2012 Kaiser Permanente 10

11 Our Numbers: Sources of Membership Employment Based Groups - 77% Medicare & Medicaid - 18% Individuals - 5% Copyright 2012 Kaiser Permanente 11

12 External Validation of Our Quality In the National Committee for Quality Assurance s 2012 Health Insurance Plan Rankings, all eight Kaiser Permanente commercial plans were rated in the top 10% of the 474 ranked national plans. According to the 2012 Medicare star quality ratings: Kaiser Permanente s California, Northwest, Hawaii, and Colorado Medicare plans received the highest possible rating of 5 out of 5 stars. Our Ohio, Georgia, and Mid-Atlantic States Medicare plans received 4.5 stars also great scores. Copyright 2012 Kaiser Permanente 12

13 Leading in Preventive and Clinical Measures: Healthcare Effectiveness Data and Information Set (HEDIS) Copyright 2012 Kaiser Permanente 13

14 External Validation of Our Quality On four broad sets of Joint Commission inpatient process measures (related to heart attack, heart failure, pneumonia, and surgical care improvement), almost all Kaiser Permanente hospitals score above the 90 th percentile. Our average risk-adjusted hospital mortality rate among Medicare beneficiaries is below the U.S. benchmark for Medicare (age 65 and older). Copyright 2012 Kaiser Permanente 14

15 but market-leading health care is not enough. 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 Copyright 2012 Kaiser Permanente 15

16 Driving Performance Through Incentives Permanente physicians are all salaried, based on median salaries in their specialties and geographic areas, and receive generous benefit packages. A small incentive bonus (less than 10%) is awarded if both the facility (practice site) and the individual physician achieve some specific quality measures. Copyright 2012 Kaiser Permanente 16

17 How We Measure Physician Performance Physicians have goals related to: Quality Access Service at the individual, department, and medical center levels. Their performance in these areas compared to local and regional averages affects their bonus as well as their annual pay raise. Copyright 2012 Kaiser Permanente 17

18 Sample Quality Goals Childhood immunizations Breast cancer screening Chlamydia screening Tobacco counseling Diabetes glycemic control LDL control Blood pressure control Medication control (asthma, antibiotic, ACE-I, lipid-lowering) Copyright 2012 Kaiser Permanente 18

19 Provider-Level Revealing Report 85.0% 80.0% 75.0% SRO FMS HypertensionControl Individual Physician Performance December 2005 Hypertension Control 70.0% 65.0% 60.0% 55.0% 50.0% 45.0% 40.0% Copyright 2012 Kaiser Permanente 19

20 Measurement drives improvement! Copyright 2012 Kaiser Permanente 20

21 Our Strategy Our strategy is to be the leader in providing high-quality, affordable health care through our integrated care delivery system, our focus on total health, and advanced technology. Community Benefit Making a Measurable Impact on the Health of the Communities We Serve Integrated Care Delivery Differentiator Health Plan Capabilities Competitive Leverage our integrated care delivery system as our key differentiator in quality, service, and affordability through innovations in care and a focus on total health. Harness technology and our data assets to enable the best tools and care innovations which continuously improve our care, service, and efficiency. Continue to lead in technologyenabled and data-supported health care, creating a paperless, patient-focused health system. Keep pace with competitors health plan products, services, and technology, meeting the evolving needs of our customers and the requirements of regulators. Collaboration and Alignment Working Through Partnerships Copyright 2012 Kaiser Permanente 21

22 Our Mission and Vision Mission: to provide highquality, affordable health care services and to improve the health of our members and the communities we serve. Vision: To be a leader in Total Health by making lives better. Copyright 2012 Kaiser Permanente 22

23 Our Model Social purpose Quality-driven Shared accountability for program success Integration along multiple dimensions Prevention and care management focus Permanente Medical Groups Health Plan Members Kaiser Permanente defines the integrated model of health care financing and delivery through its unique partnership among three entities. Kaiser Foundation Hospitals Kaiser Foundation Health Plan Copyright 2012 Kaiser Permanente 23

24 Kaiser Permanente s Structure Kaiser + Permanente Kaiser Foundation Health Plan, Inc. National Partnership Agreement The Permanente Federation, LLC Regions Medical Service Agreements/ Memorandums of Understanding Articles of Federation Permanente Medical Groups 24

25 Our Model In California, where 75% of our membership resides, we offer one-stop shopping for most services. (We contract for a few of these services in several smaller regions.): Copyright 2012 Kaiser Permanente 25

26 Information Technology: Kaiser Permanente HealthConnect More than just an electronic medical record The development and deployment of a highly sophisticated information management and delivery system A Program-wide system that integrates the clinical record with appointments, registration and billing A complete health care business system that enhances the quality of patient care Return on investment estimated at 8.5 years (but this was a strategic investment, not based on ROI) Copyright 2012 Kaiser Permanente 26

27 Scope of Kaiser Permanente HealthConnect Web Access Portal Ancillaries Care Delivery Core Health Plan Finance Outpatient Pharmacy Outpatient Scheduling Inpatient Scheduling Membership/ Benefits General Ledger Lab Radiology/ Imaging Others (immunizations, EKG, dictation) Registration Clinicals Billing Admission, Discharge, and Transfer Clinicals Pharmacy Emergency Department Operating Room Billing Referral & Utilization Management Claims Processing Benefits Accumulation Pricing System Capital Planning Financial Reporting Data Warehouse / EDR Enterprise Data Repository Copyright 2012 Kaiser Permanente 27

28 Expanded Online Access for Members Member Web Portal Access medical record Make/change appointments Care Delivery Core Scope of KP HealthConnect Suite Outpatient Inpatient Send to doctor Check lab results Access health Information Review eligibility & benefits Account summary Scheduling Registration Clinicals Billing Scheduling Admission, Discharge, and Transfer Clinicals Pharmacy Emergency Department Operating Room Billing Copyright 2012 Kaiser Permanente 28

29 Copyright 2012 Kaiser Permanente 29

30 2012 Learnings from the Kaiser Permanente Model Programs November in program in San Francisco for international visitors: Learnings from the Kaiser Permanente Model: Integration and Innovation in Health Care For more information, go to kp.org/international Copyright 2012 Kaiser Permanente 30

31 Thank You! Copyright 2012 Kaiser Permanente 31

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