Quality and Innovation Centers: Kaiser Permanente

Transcription

1 M14 These presenters have nothing to disclose. Quality and Innovation Centers: Kaiser Permanente By: Alide Chase, senior vice president Medicare Clinical Operations and Population Care And Lisa Schilling, RN MPH vice president Healthcare Performance Improvement Care Management Institute December 10, :30am 12:00 pm Our Numbers 8 regions serving 9 states and the District of Columbia 8.9 million members (as of 2/11) 15,000 physicians 164,000 employees (including 45,000 nurses) 37 medical centers (with hospitals) 454 medical offices (ambulatory care buildings) $44 billion operating revenue (2010) 2 1

2 Kaiser Permanente Quality Improvement Journey Established strategic partnership with IHI Develop enterprise quality strategy KP HealthConnect implementation begins Assess baseline capability to improve Estalish KP s big dots the Big Q Some best performance in KP and high variation Establish IHI scholarship program for KP and safety net Develop Improvement Institute Hire master black belt mentors Adopt IHI s execution model in medical centers Focus on alignment, portfolio management achieving scale Deepen commitment to analytics, evaluation and research KP HealthConnect fully implemented, optimizing More PSO graduates than any other organization Targeted participation in IHI programming based on strategic need 2011-Beyond Align innovation, improvement in key strategies Focus on technology integration, informatics and improvement at scale Develop deep capability at regional levels Expand capability to operate as a learning organization via networks and KM 4 part series published in the Joint Commission Journal KP NCQA results, Medicare Stars best in class performance across KP Created Clinical Effectiveness Research Center Focus on total health 3 Our system is based on the attributes of high performing organizations KP builds capability in these six areas in order to achieve breakthrough performance Best quality Best service Most affordable Best place to work Kaiser Permanente 2010 reproduce by permission only 2

3 High Performing Organizations Build Culture and Capability Principles What we do Top down Reduce variation Define organizational needs Create system view Plan/ manage improvement Economic and social context for change Models of workplace learning Team performance Learning system Align with strategy ID drivers and portfolios Build capability to improve Engaging the hearts and minds of the front line Creating line of sight to strategic goals Define high performing unit-based teams Bottom up Learning and improvement Kaiser Permanente 2010 reproduce by permission only Building Will Define Breakthrough goals Source: IHI 2008 Spread and sustain Provide Leadership for Large system Projects Manage Local Improvement Provide Day-to-Day Leaders for Micro Systems Develop Capability Source: IHI Kaiser Permanente 2011 reproduce by permission only 3

4 Will: From Strategy to Execution Big Aim Strategy Dashboard Targets DO NOT INCLUDE IN AUDIENCE PACKET FOR LIVE PRESENTATION ONLY P8 Inpatient Mortality: All KFH HSMR continues below US Medicare benchmark. HEDIS: KP performance continues to trend above the national 90th Percentile T JC: The combined TJC composite for all KFH hospitals continues to be less than one point from 100% - the national 90 th percentile Safety: At risk for meeting SRAE 10% reduction goal; will not achieve RFO/VI goals Equitable Care: The gap between the Black or African American and White rates is 3.3 points; the disparity was 4.0 points a year ago. Risk Mgmt: 15% improved performance seen in 2010 was sustained in 2011 Service-METEOR: Health Care Rating: Programwide sustained gains from prior year s significant increase, and remains above the national 75th percentile by Service-HCAHPS Overall Rating demonstrated a significant 3.3 point increase from the previous year. Nurse Communication also showed a significant 2.4 point improvement from previous year. Resource Stewardship: No threshold has been established for this new top level metric, commercial HMO risk adjusted selected services cost PMPM. 4

5 Ideas: Manage Local Improvement Define Breakthrough goals Source: IHI 2008 Spread and sustain Provide Leadership for Large system Projects Manage Local Improvement Provide Day-to-Day Leaders for Micro Systems Develop Capability Kaiser Permanente 2011 reproduce by permission only 9 Identifying Levers of Improvement: Driver Diagrams 10 5

6 Harvesting of Ideas: Scanning Problems Just Do It Improve It or Adopt It Create It Outcomes Elder Health Palliative Care Program Length of Stay for THR New Model of Elder Care Healthy Quality of Life Falls With Injury Toileting & Rounding Bundle ID high risk from medications Injury-free Floors; Delirium Prevention No Falls With Injury Kaiser Permanente 2011 reproduce by permission only 11 Develop Capability for Execution Define Breakthrough goals Spread and sustain Provide Leadership for Large system Projects Manage Local Improvement Provide Day-to-Day Leaders for Micro Systems Source: IHI Kaiser Permanente 2011 reproduce by permission only Develop Capability 6

7 Thi s im 12/11/2012 Content: What Skills Do We Need? Many People Few People Everyone (Staff, Supervisors, UBT lead triad) Shared Knowledge Change Agents (Middle Managers, Stewards, project leads) Operational Leaders (Executives) Continuum of PI Knowledge and Skills Experts Deep Knowledge Kaiser Permanente 2010 reproduce by permission only A key operating assumption of building capacity is that different groups of people will have different levels of need for PI knowledge and skill. Our approach will be to make sure that each group receives the knowledge and skill sets they need when they need them and in the appropriate amounts. Developing deeper capability to achieve big results over time Waves of Improvement Institute September 2008 June & 2011 Develop and Test the System at a Facility level 5 regions 65 Improvement Advisors 300 operations managers 3,500 Front line staff IHI Forum Expand Improvement system to all facilities 7 regions 300 Improvement Advisors 35 UBTC s 1,250 Operations managers 8,000 Front line staff IHI Forum and courses Deepen improvement knowledge within facilities All Regions 500 IA s 15 internal faculty Mentors 3,000+ Operations Managers 20,000+ Front line staff IHI Forum and courses Learning and sharing systems regionally and program-wide Improvement Institute Level of Project Difficulty Complete On-boarding Implementation Expansion Continuous Improvement We are here Kaiser Permanente 2010 reproduce by permission only 7

8 Improvement Institute Week 1 Medical Center Assess, Plan Week 2 Medical Center Test, Implement SPC Control Results 1,200 Graduates $200 Million 90 Days: Apply Learning and Get Results 15 Kaiser Permanente 2010 reproduce by permission only Regional Case Study: Sepsis Care Across 20 Medical Centers Video NCAL Sepsis 8

9 Multi-hospital Results: Reducing Mortality from Severe Sepsis 26% Decline in mortality 18% Decline in LOS 1,135 Lives saved $56MM Over-utilization avoided Kaiser Permanente 2010 reproduce by permission only Tremendous Improvement in Member Satisfaction with the Health Care they Receive P18 Ambulatory Service Performance: CAHPS Health Care Rating % of respondents rating all health care in last year as, 9, or 10 on a scale of 0 to 10 (from worst possible to best possible) 75 th percentile Interregional CAHPS improvement workgroup formed sharing best internal and external practices Legend: Blue = Program trend Black = CAHPS benchmark Drivers Focus on leadership Alignment of goals Engagement of front-line Key Initiatives Access improvement practices Communications Culture of Excellence 9

10 Leveraging the Power of Electronic Health Records: Improved Ambulatory Care Ambulatory Performance: HEDIS Composite P19 % of eligible members receiving appropriate ambulatory care (PY Year 2008) PY = Performance Year Drivers Population care Decision support KP.org Clinical Effectiveness Inpatient Outcomes: Hospital Standardized Mortality Ratios P20 Ratio of observed to expected mortality KP - All Facilities US Medicare Overall Kaiser Foundation Hospital DO NOT INCLUDE IN AUDIENCE PACKET FOR LIVE PRESENTATION ONLY 0.2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q

11 P21 Current Challenges Alide Chase, SVP, Medicare Clinical Operations and Population Care Medicare Care Delivery Our Big Challenges P22 How to provide outstanding care in both clinical quality and care experience to our Medicare members while reducing total cost of care? Answer: Reliably execute on proven care Remove variation Transform care delivery Design entire system to be member/patient focused 11

12 Values P23 KP's commitment to high quality of care and an excellent service experience are top priorities in the organization. This commitment remains in place and serves as a "true north" as we face significant challenges with health care reform. The focus on patient safety, particularly in our hospitals is a key component of the plan. All of the Medicare initiatives will result in improved quality and service with improved efficiency and effectiveness that will help make healthcare more affordable for our members. Our National Work Spread and Execution of Proven Care Reduce Variation Accelerate the Development Cycle Align Care to Member Needs Engage all of Kaiser Permanente 12

13 Care Delivery Needs Differ Across Segments Medicare Segmentation Healthy Chronic Conditions Advanced Illness P25 Severe Frailty/ End of Life Care Needs Usual Care Population Care Complex Care Percent of Members 15 to 20% 60 to 65% 10 to 15% 5 to 7% PMPM Expense Ratio 1X 2-3X 5-8X 15-20X Data Capture and Predictive Ability P26 Personalizing Care through Segmentation SEGMENT 1: Healthy / Robust SEGMENT 2: Chronic Conditions SEGMENT 3: Advanced Illness SEGMENT 4: Severe Frailty / End-of-Life Moira M Belikoff

14 Insert Kat diagram here Medicare Plan: Three Buckets of Work First 5 What we know and do well + Unwarranted Variation + Transformation Excellence P28 Palliative Care Transitions Bone Health SNF ALF Rounding Clinical Onboarding Decrease unwarranted admissions & readmissions Decrease unwarranted variation in services New provider roles Medical home Self Care Automation Care Planning Telemedicine Technology-enabled community health workers 28 14

15 Goal/Aim Primary Drivers Hypotheses - Secondary Drivers 29 Health Most health Care Best care Most affordable Best people Affordability People Unwarranted Variation Act and Go Beyond Selected areas based on KP s actionability and improvement of care : EKG, angiography and imaging tests for low risk cardiac patients Antibiotics and imaging for sinusitis and headache Percent of women with second pap smear within 2 years, 6 months Redundant visits year after breast cancer is cured Screening PSA in men over 75 years of age Overly tight glucose control in some older adults with diabetes Using anticholinergic medications as a first line treatment of urinary incontinence in older adults 15

16 Transformation Scanning Results We have identified promising tactics across all care delivery domains No single strategy (internal or external) was both high potential impact and just spread now Need to design and test our hypotheses for new operations and workflows to achieve our goals Innovation that Supports Transformation Now Hospital to Home: Identify way to move inpatient close to home Clinic to Home: Move ambulatory care from clinic to Everywhere with telemedicine Integrate Complex Geriatric Care: Segment 3 & 4 Example of Programs Identified P32 American Physician House Calls from TX Advanced Illness Care Coordination- Aetna Grand-Aides Clinically Home Pacific Group on Health -CMS Woodland Hills Geripal Program Telepresence visits in local clinics Healthy Bones Sheffield Teaching Hospitals Univita Health SILvR Network Initiative SeniorBridge Ben Archer Health Center Pittsburgh Regional Health Initiative Proactive Office Encounter Work Kaiser Special Services (KSS) Heart Failure Transitional Care Dementia Care Birmingham, RAID Community Care of North Carolina (CCNC) medicare innovations collaborative St. Vincent Hospital (indianapolis) Beth Israel Deaconess PACT Providence Portland Medical Center Complex Medical Home- KPCares Clinical Decision Units KPCO PATHWAAY for Seniors. Transforming Community Service Nurses Improving Care for Healthsystem Elders Six Features of effective coordinated care Care of the Elderly, England CareFirst BlueCross Care and Cost Improvement UCLA Alzheimers and dementia care Guided Care Program PE 65 One Stop Shop for Palliative Care Primary Care and Public Health GRACE Team Care (Indiana University) Janus Health Med Stat U. of Missouri LIGHT^2 - CMS St. Francis Healthcare Hawaii Assisted Living Facility Program AICC Pilot San Rafael Delerium Management Initiative Stanford AICU Teaching Geriatric Skills to Hospitalists Council of Aging of Southwestern Ohio Ocean Medical - Advanced Care Elderly Developmental Disabilities Health Sanford Health integrated primary care DriveABLE Geriatric ED Pioneernetwork.n et Capital Health Plan Housecall Providers, Inc.( in Portland) Erie St. Clair CareSouth Carolina Emory Critical Care -CMS Sutter Advanced Illness Management (AIM) Relay for Life Advance Care Planning Respecting Choices INTERACT Brooklyn House Calls Dementia Care "Aging Brain Care" Indiana U UPENN transitional care model Northwest Advancing Quality Alliance Innovative Oncology Business Solutions Indiana University Community Rx System Memory Clinics Wellness Clinics Acute Care for Elders Vitality 360 Hospital at Home -Presbyterian Care Transitions Hospital at Home CAPABLE for frail dually eligible- Johns Hopkins University Emergency Medical Services Home Visits Elder Care Clinic HELP (Yale) Novant Health - private duty nursing ACP Pilot in Palo Alta Janssen Connected Care Challenge Finalists Population Care Management Delirium detection and prevention - Methodist Vanderbilt med center - CMS Palliative Care Stand Alone Clinics Virtual Specialist PACE UCLA Scribing 16

17 Transformation Spaces High potential / high value tactics We can improve care across our entire landscape of settings and strategies to provide the right care at the right time in the right place. Acute, Urgent & Emergent Care Encounters Geriatric ED KP Care Settings Hospital & ED Care Transitions Technology Enabled Hosp at Home Care Settings Home Virtual Wards Community Care Settings Continuum of Care SNF / ALF HH P33 Ambulatory Care Encounters Geriatric Specialty Clinics Clinic Wellness Clinics Geriatric Med Home Palliative Care Everywhere Primary Care Home Visits Telemedicine Remote Monitoring Neighborhoods Naturally Assisted Living Occurring Rounding Retirement Communities Grand Aides Promatores Neighborhoodhood Health Centers Population Care Encounters Care / Case Management Automated Care Mgt Bone Health Clinical Onboarding Call Centers / KP.Org Self Service KP.org Self Care Mobile Appsps Social Networking Internet Care Communities Internal External Initial Demonstrations KPPG Expectations: Each Participating Region and Demonstration Will: Designate a Health Plan and Medical Group executive who will be accountable for the Demonstration outcomes Define specific affordability hypotheses that can be quantified Set targets and define metric indicators for contributions to affordability, quality, and experience for the Demonstration model, the region and KP-wide, by June 1, 2013 Show your Demonstration is on a trajectory to hit your end-of-year Demonstration targets by June 1, Shorten text here get from Jann Annie to write Show your Demonstration is on a trajectory to hit your regional targets by December 31, 2013 Be prepared to share learning and progress toward objectives on a quarterly basis beginning in December Hospital to Home Develop ways to move inpatient care closer to home Hospital to Home, Virtual Wards Clinic to Home Using telemedicine to move ambulatory care from the clinic to everywhere Virtual visits, Telemedicine, Remote monitoring Integrate Complex Geriatric Ambulatory Care Address the clinical needs and operations to support service delivery for complex members across the continuum; clinic to home to community Matching care to need: Think through how operations for the complex micro-panel will integrate with the macro-panel to achieve greater affordability 17

18 External Relationships Scanning Strategic Planning Opportunity Analysis Generative Events Leadership Dashboard MEDICARE CARE DELIVERY STRATEGY E 4 = LEARNING + ACCELERATION ENVISION Explore what s possible? Create roadmap amidst the possibilities EXECUTE Member Voice And Experience EXCITE Activate the organization Articulate vision and how we are getting there ENGAGE Internal Communications External Communications CMS Advocacy Publication Segmentation First 5 Variation Demonstrations Technology Nursing, Pharmacy, P&S, etc Test hypotheses, identify what works, and go to scale Develop key partners Create opportunities to problem solve and plan execution Clinical Disciplines Business Disciplines Internal KP Accelerators 35 Engage the Whole Organization Jann s star clusters here 18