Creating a Culture of Continuous Improvement August 2010

Transcription

1 Creating a Culture of Continuous Improvement August 2010 Molly Porter, Director, Kaiser Permanente International molly.porter@kp.org Copyright 2010 Kaiser Permanente

2 Key topics The quality and model of Kaiser Permanente The importance of measurement and incentives Public accountability: NCQA, JCAHO, etc. Motivating physicians (as well as everyone else) 2 Copyright 2010 Kaiser Permanente

3 Cost-effective, high-quality care at KP The 2010 Hewitt Health Value Initiative showed that Kaiser Permanente: Is 17% more cost-effective than all plans in the markets it serves, making it the most cost-effective plan overall. Is 117% better in clinical quality than the all-plan average in the markets it serves, making it first in clinical quality in all eight regions. 3 Copyright 2010 Kaiser Permanente

4 Our numbers 8 regions serving 9 states and the District of Columbia 8.6 million members 14,000 physicians 166,000 employees (including 41,000 nurses) 35 medical centers (with hospitals) 431 medical office buildings $40 billion operating revenue (2008) 4 Copyright 2010 Kaiser Permanente

5 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 Leverage our integrated care delivery system, which is founded on collaborative partnerships with our medical groups, hospitals, health plan, and labor partners, as our key differentiator in quality, service, and affordability through innovations in care and a focus on total health. Harness the value of technology and our data assets to enable the best tools and care innovations which continuously improve our care and efficiency. Continue to lead in technology-enabled and data-supported health care, creating a paperless, patient-focused health system. Health Plan Capabilities Competitive Offer competitive health plan products and services that meet the needs of our customers and create a customer and patient base for our health care system. Collaboration and Alignment Working through Partnerships 5 Copyright 2010 Kaiser Permanente

6 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 6 Copyright 2010 Kaiser Permanente

7 If you can t measure it, you can t manage it Look at baseline data percentages, numbers, dollars, or ratings and continuously monitor performance. 7 Copyright 2010 Kaiser Permanente

8 Incentives are important Incentives are the cornerstone of modern life. And understanding them is the key to solving any riddle, from violent crime to sports cheating to online dating.... But most incentives don t come about organically. Someone has to invent them. - Freakonomics: A Rogue Economist Explores the Hidden Side of Everything, Steven D. Levitt and Stephen J. Dubner 8 Copyright 2010 Kaiser Permanente

9 Creating incentives Small bonuses (between 3% and 10%) linked to goals with measurable results create big incentives. Leaders who support, acknowledge, and reward their staff (physicians or others) make a huge difference. Teamwork is a powerful motivator people like to be part of something bigger than themselves. At KP, almost all employees (not just physicians) have small financial incentives, and many of these are based on group performance. 9 Copyright 2010 Kaiser Permanente

10 It starts at the top Leaders must articulate a mission, vision, and strategy for a region or a program. These need to be operationalized at the medical center, department, and individual level. Goals need to be measurable and achievable. 10 Copyright 2010 Kaiser Permanente

11 Our strategic imperatives Achieving our strategic imperatives will allow us to deliver on our strategy and be the model for the future of health care. Community Benefit Making a Measurable Impact on the Health of the Communities We Serve Strategic Imperatives Areas of Focus Transforming Care Delivery Achieving Best Quality and Service Leading Prevention and Total Health Leading Care for Chronic Conditions Best Hospitals Service Excellence Enabling Performance Through People Being the Best Place to Work Great People Workforce Effectiveness Health and Safety of Our People High-Performance Culture Implementing Infrastructure Realizing Value Care Delivery Settings Care Delivery Systems / Tools Health Plan Systems / Tools Business Systems / Tools Improving Cost Structure Bending the Trend Appropriate Utilization Care Delivery Efficiency Administrative Efficiency Growing into Capacity Growing Membership Expanding Access to KP Care Price Point and Sustainable Pricing Strategies Marketing, Products, Sales and Distribution Customer and Member Service, Administration and Retention Facility Enhancement and Geographic Expansion 11 Copyright 2010 Kaiser Collaboration Permanente & Alignment Working through Partnerships

12 How KP employees rate KP as an employer: 2009 People Pulse survey How we compare NoCal KP Other Health Care Recommend as a good place to work Proud to tell people I work here 85% 73% 91% 77% Opportunity for career growth 74% 45% Receive training needed to do job well Trust information from leaders 79% 66% 66% 56% 12 Copyright 2010 Kaiser Permanente

13 Public accountability: national and state organizations National and state private not-for-profit organizations Health plan accreditation status from the National Committee for Quality Assurance (NCQA ) Clinical effectiveness of care measures of performance from the Health Plan Employer Data and Information Set (HEDIS ) Hospital accreditation status and national quality improvement goals from The Joint Commission Collaborative statewide hospital report card from the California Hospital Assessment and Reporting Taskforce (CHART ) National and state public/government sponsored Health plan member satisfaction from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Overall California HMO Ratings California Office of the Patient Advocate 13 Copyright 2010 Kaiser Permanente

14 Public accountability: national and state organizations (continued) National employer sponsored Hospital patient safety from The Leapfrog Group Health plan clinical quality and efficiency from the National Business Coalition on Health's evalue8 (NBCH evalue8 ) Physician group clinical care ratings from the Integrated Healthcare Association from the State of California Office of the Patient Advocate from the California Cooperative Healthcare Reporting Initiative 14 Copyright 2010 Kaiser Permanente

15 NCQA: health plan accreditation NCQA began accrediting U.S. managed care organizations in 1991, in response to the need for standardized, objective information about the quality of these health care organizations. Accreditation is a rigorous and comprehensive evaluation process through which NCQA assesses the quality of the key systems and processes that define health care organizations. Accreditation includes an assessment of the care and service that plans deliver in important areas such as childhood immunizations and ensuring that women receive mammograms as appropriate. Employers, consumers, regulators, and health plans turn to NCQA Accreditation as the gold standard in evaluating health care quality. NCQA regularly revises and improves standards in order to keep the Accreditation Program current and to address pressing health care issues. 15 Copyright 2010 Kaiser Permanente

16 Kaiser Permanente s performance goal Kaiser Permanente seeks to provide care at the top- 10-percentile of performance nationally. In fact, we are leading the nation in 17 separate areas of HEDIS quality measurements - such as breast cancer screening rates and the management of diabetes, cardiovascular care, and asthma - for both Medicare members and commercial members. 16 Copyright 2010 Kaiser Permanente

17 Leading in preventive and clinical measures: Healthcare Effectiveness Data and Information Set (HEDIS) Breast Cancer Screening Childhood Immunization Status 3 HEDIS Measures 2009 MARKET RANKING 1 NCAL SCAL HI NW CO GA MAS OH Chlamydia Screening in Women Antidepressant Medication Management, Acute Phase Treatment Antidepressant Medication Management, Continuation Phase Treatment Diabetes Blood Pressure Control Diabetes Medical Attention Neuropathy KEY: First in the Region Second in the Region 17 Copyright 2010 Kaiser Permanente 1 Based on HEDIS 2009 Commercial results and NMR Competitors.

18 Kaiser Permanente as a leader Kaiser Permanente has the top-ranked health plans in the nation in both Medicaid and Medicare, according to a joint ranking by U.S. News & World Report and the National Committee for Quality Assurance. Kaiser Permanente Northern California was singled out by NCQA for excellence in the management of cardiovascular disease. Overall mortality in KP is 30% lower than that of the community. 18 Copyright 2010 Kaiser Permanente

19 The role of physician leaders Physician leaders should support, acknowledge, and reward terrific physicians, but they must only protect patients. Their traits should include: Highly respected clinician Emotional intelligence Enterprise ownership Passion/positivity Communication skills 19 Copyright 2010 Kaiser Permanente

20 You get what you pay for If you pay more for physicians to perform more services regardless of quality, you ll get overutilization. If you pay more for physicians to perform fewer services regardless of quality, you ll get underutilization. The capitated system works best for appropriate use of resources, but it works best in an integrated system. 20 Copyright 2010 Kaiser Permanente

21 How physicians are compensated Kaiser Permanente uses market-based research to determine median starting salaries for each specialty for each region of the country to make sure we are competitive in attracting physicians. Our benefit packages are richer than the market, bringing total compensation up above the median in the market. After a three-year trial period of careful performance reviews and input from their peers, physicians may be invited to join the Permanente Medical Group. 21 Copyright 2010 Kaiser Permanente

22 How physicians are compensated (cont.) Physician pay is more than 90% salary in most Permanente Medical Groups. A small incentive bonus (less than 10%) is awarded if both the facility (practice site) and the individual physician achieve some specific quality measures (usually HEDISlike). There is no pay based on utilization, cost, or other financial measures. 22 Copyright 2010 Kaiser Permanente

23 How we measure physician performance Physicians have goals related to: Quality Access Service at the individual, department, and medical center level Their performance in these areas compared to local and regional averages affect their bonus as well as their annual pay raise. 23 Copyright 2010 Kaiser Permanente

24 Sample quality measures (vary by year and region) Childhood immunizations Breast cancer screening Chlamydia screening Tobacco counseling Diabetes gylcemic control LDL control Blood pressure control Medication control (asthma, antibiotic, ACE-I, lipid-lowering) 24 Copyright 2010 Kaiser Permanente

25 Making it easier to do the right thing: breast, cervical, and colorectal cancer screening Regional letters or s sent to all due members at designated period of time from due date Reminder letters and follow-up letters or s sent at other designated times Additional regional support Monthly outreach lists sent to facilities Support with local tools Local outreach practice Follow-up to regional letters with phone calls Calls and s to overdue members 25 Copyright 2010 Kaiser Permanente

26 Sample access and service measures Sample access measures: Time it takes patient to schedule an appointment with their primary care physician Time it takes physician to respond to patient s Sample service measures: How patients respond to patient satisfaction surveys asking about relationship with physician and perception of treatment/partnership 26 Copyright 2010 Kaiser Permanente

27 Sample hospital measures Inpatient quality: Survival rates from heart attack, pneumonia, surgical infection prevention, sepsis Patient safety: Hospital-acquired pressure ulcers, surgical never events (such as wrong-site surgery), hospital-acquired infections Patient satisfaction: How patients rate their stay in the hospital (mostly a measure of nursing care) 27 Copyright 2010 Kaiser Permanente

28 Opening the gate to incentives Before incentives can be awarded, Kaiser Permanente must do well as a program both in terms of its operating budget and its overall goals. $ is then distributed at the facility level, and local leaders decide how to allocate bonuses and raises; they may decide instead to hire more physicians or staff. 28 Copyright 2010 Kaiser Permanente

29 Professional satisfaction: Independent studies conducted by researchers at the University of California have found Kaiser Permanente physicians to be more satisfied with their work environment and to feel better supported in providing quality care and service. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent of Physicians Reporting Participation to be an Advantage 59% 16% 69% 29 Copyright 2010 Kaiser Permanente 51% 93% 34% Quality of Care Attracting Patients Shared Practice Responsibilities Source: Grumbach, et. al., California Physicians 2002: Practice and Perception 77% 38% Practice Viability Permanente Physicians Office- Based Physicians

30 In summary Corporate culture must be created by leadership and reinforced by engaging physicians and employees at all levels. Measurable and achievable goals with a small incentive attached are key to continuous improvement. 30 Copyright 2010 Kaiser Permanente