Kaiser Permanente: Integration and Innovation in Health Care

Transcription

1 Kaiser Permanente: Integration and Innovation in Health Care December 2017 kp.org/international Copyright 2017 Kaiser Permanente

2 Changing mindsets, changing care delivery Industrial Age Model of Care One patient at a time Only know about patients who appear in your office No use of information technology Limited use of nonphysicians Information Age Model of Care Accountability for panel/population Transparency Use of EMR, registries, internet Team care (including patient) Moving care out of doctor s office Copyright 2017 Kaiser Permanente, Slide 2

3 What is Kaiser Permanente? Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of the leading health care providers and not-for-profit health plans in the United States. 1. We bring together health care services and insurance coverage. 2. Most of our health care services are under one roof. 3. Members have the support of an entire care team. Copyright 2017 Kaiser Permanente, Slide 3

4 Kaiser Permanente s mission and vision Mission: To provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Vision: We are trusted partners in total health, collaborating with people to help them thrive, creating communities that are among the healthiest in the nation, and inspiring greater health for America and the world. Copyright 2017 Kaiser Permanente, Slide 4

5 Our markets and membership (as of July 2017) KP Washington & Northwest (Oregon and Washington state) 1,256,000 members Mid-Atlantic States (D.C., Virginia, and Maryland) 705,000 members California 8,521,000 members Hawaii 251,000 members Copyright 2017 Kaiser Permanente, Slide 5 Colorado 675,000 members Georgia 310,000 members

6 KP membership by line of business (as of February 2017) INDIVIDUAL 9% MEDICARE 13% EMPLOYER GROUPS 70% MEDICAID / CHIP & CHARITABLE HEALTH COVERAGE 8% 11.6 Million Members Copyright 2017 Kaiser Permanente, Slide 6

7 Kaiser Permanente Where we started Where we are now ,500 members 26 physicians 210 employees* (*estimated) 2017 (as of August) 11.7 million members 22,000 physicians 208,000 employees (including 54,000 nurses) 72 years of helping people and communities thrive 8 regions serving 8 states and Washington, D.C. 39 hospitals (co-located with medical offices) More than 670 medical offices and other outpatient facilities Copyright 2017 Kaiser Permanente, Slide 7

8 Our Redwood City Medical Center in Northern California Copyright 2017 Kaiser Permanente, Slide 8

9 One-stop shopping for most services Ambulatory/outpatient care Audiology and optometry/ophthalmology Diagnostic imaging, laboratory, and pharmacy Emergency care and hospitalization* Health education and preventive care Home health care Labor and delivery (childbirth) Mental health and wellness Occupational health (workers compensation) Physical therapy Primary care working closely with specialty care, surgeons, hospitalists* * Note: In Colorado, Georgia, and the Mid-Atlantic States, we contract with community hospitals for beds and some specialty care. Copyright 2017 Kaiser Permanente, Slide 9

10 KP history (Notable time periods) Kaiser Permanente evolved from industrial health care programs for construction, shipyard, and steel mill workers for the Kaiser industrial companies during the late 1930s and 1940s to Henry J. Kaiser hired Dr. Sidney Garfield and Associates to provide prepaid health care for construction workers in the Northwest and shipyard workers in Northern CA ~1950 to During the McCarthy era, the American Medical Association (AMA) and local medical groups challenged KP for offering socialized medicine. (Labor unions rallied to support KP.) Late 1990s crisis For the first time, KP lost $ (2 years in a row). This led to a laser focus on our mission of high quality, affordable care 1938 to to Late 1990s 2010 July 21, 1945 First opened to public enrollment Copyright 2017 Kaiser Permanente, Slide Beginning of current KP model (Three entities with exclusive contracts Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and Permanente Medical Groups) 2010 KP HealthConnect was fully implemented, and KP started to lead the U.S. in quality.

11 Innovative ideas from the beginning Prepayment Group practice Prevention/total health Population-based approach Clinical information technology Photo: Sidney Garfield, MD (left): a surgeon, visionary, and trailblazer Henry J. Kaiser (right): an entrepreneur who revolutionized shipbuilding and started global enterprises, including cement, steel, aluminum, and automobiles Copyright 2017 Kaiser Permanente, Slide 11

12 What s in a name? Kaiser Permanente is a trade name owned by Kaiser Foundation Health Plan, Inc. It is not an entity. Kaiser Permanente describes an integrated delivery and financing system conducted by three sets of entities that operate through contracts with one another: the Kaiser Foundation Health Plans, Kaiser Foundation Hospitals, and the Permanente Medical Groups. The relationship between the parties is not a partnership or joint venture. It is purely contractual. Copyright 2017 Kaiser Permanente, Slide 12

13 What makes Kaiser Permanente unique? Our structure Kaiser Permanente is composed of Kaiser Foundation Health Plans, Kaiser Foundation Hospitals, and the Permanente Medical Groups Members Individuals & Employer Groups Kaiser Foundation Health Plan (KFHP) Owns Facilities Kaiser Foundation Hospital (KFH) Labor-Management Partnership (LMP) Medical Service Agreement PMGs (Southern California Permanente Medical Group) Copyright 2017 Kaiser Permanente, Slide 13

14 Medical center structure (Our Medical Management Partnership) (K) Kaiser (P) Permanente Sr. VP & Area Manager Chief Administrative Officer Area Medical Director Assistants Assistant Medical Group Administrator Assistant Area Medical Director Department Administrators Department Administrators Chiefs Copyright 2017 Kaiser Permanente, Slide 14

15 Our strategic framework To advance the health of our members and communities we serve, our strategy outlines a plan to perform, grow, and lead. Copyright 2017 Kaiser Permanente, Slide 15

16 Kaiser Permanente HealthConnect Kaiser Permanente typically spends about 6% of our total revenue on information technology. KP HealthConnect (our integrated system for care delivery) is: Implemented between 2004 and 2010, KP HealthConnect is the largest civilian health information technology system in the United States. More than just an electronic medical record, KP HealthConnect integrates the clinical record with appointments, ancillary and specialty services, registration, and billing. KP HealthConnect includes a personal health record accessed with a username and password (70% of members over age 13 currently signed up) In the U.S., a major health care IT achievement is to be a Stage 7 hospital (paperless). Almost all of Kaiser Permanente s hospitals and medical offices have achieved this. Copyright 2017 Kaiser Permanente, Slide 16

17 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 Membership/ Benefits Claims Processing Benefits Accumulation Pricing System General Ledger Capital Planning Financial Reporting Billing Data Repository Copyright 2017 Kaiser Permanente, Slide 17

18 KP HealthConnect enables All care information. All patients. All the time. Availability of patient s chart before KP HealthConnect Availability of patient s chart after KP HealthConnect 100% 100% 100% 40-70% >5% 5% Phone ER Visit Phone ER Visit Copyright 2017 Kaiser Permanente, Slide 18

19 Anytime, anywhere access With the KP app, members can: locate facilities access medical records order/refill prescriptions make appointments care providers view test results 61% of our transactions on kp.org are via mobile devices. Copyright 2017 Kaiser Permanente, Slide 19

20 kp.org Kaiser Permanente s website Copyright 2017 Kaiser Permanente, Slide 20

21 Redefining appointments: all care Source: UCDA Core Value Metrics Copyright 2017 Kaiser Permanente, Slide 21 21

22 The Fegraus family s story (Video appointments) KP conducted 42,000 video visits in 2016, which do not yet show up as a percentage in the previous graph. Copyright 2017 Kaiser Permanente, Slide 22

23 Health care transformation Hospital with hospitalbased specialty care Care anywhere Micro-clinics Primary care / ancillaries Specialty hub with primary care Mobile services Employer clinics Mobile health Web Home as the hub Telemedicine Care anytime Copyright 2017 Kaiser Permanente, Slide 23 :: ::

24 KP International participant countries Since 2004, Kaiser Permanente International s programs have attracted participants from 60 countries. April : Three-day program in San Francisco Copyright 2017 Kaiser Permanente, Slide 24

25 Future KPI offerings (see kp.org/international) April 16-18, 2018: Three-day program in San Francisco Bay Area April : Three-day program in San Francisco Two-day customized programs in California or Washington, D.C. Videoconferences or Skype presentations Presentations or seminars in your country Copyright 2017 Kaiser Permanente, Slide 25

26 For more online information about KP kp.org/international (click on About Kaiser Permanente) April : Three-day program in San Francisco share.kaiserpermanente.org (click on About Us) KaiserPermanenteCareStories.org (stories about our patients) kp.org/ataglance (quick, up-to-date aspects of our annual report) Copyright 2017 Kaiser Permanente, Slide 26