Kaiser Permanente: Integration, Innovation, and Capitation in Health Care

Transcription

1 Kaiser Permanente: Integration, Innovation, and Capitation in Health Care November 9, 2017 Molly Porter, MS, Director, Kaiser Permanente International kp.org/international Copyright 2017 Kaiser Permanente

2 How do Switzerland and the U.S. compare in health expenditures and life expectancy? Switzerland $6,787 per capita spent on health care #2 in the world for life expectancy: 83.4 years The United States $9,024 per capita spent on health care #31 in the world for life expectancy: 79.3 years Note: As a percentage of Gross Domestic Product (GDP) spent on health care, the U.S. spends more than any other country. Switzerland ranks among the top five spenders. 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 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 5

6 Kaiser Permanente by the numbers (year-end 2016) Operating revenue: $64.6 billion (averages $6,000 per member per year although premiums vary widely) Operating income: $1.9 billion Capital investment: $2.8 billion (includes technology, facilities, etc.) Community investment: $2.5 billion (to improve the health of our communities through subsidized premiums, health education, community parks and bike trails, etc.) Copyright 2016 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 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 three regions, we contract with community hospitals for beds and some specialty care. Copyright 2017 Kaiser Permanente, Slide 8

9 What makes Kaiser Permanente unique? Our structure Kaiser Permanente is composed of Kaiser Foundation Health Plans, Kaiser Foundation Hospitals, and 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 9

10 External validation of our overall quality Kaiser Permanente continues to earn top quality, service, and customer satisfaction scores from the National Committee for Quality Assurance and J.D. Power as well as many other accrediting bodies. The consulting firm Aon Hewitt reported that, based on 2015 performance data, Kaiser Permanente is 17% more cost-effective and 217% better in quality than the all-plan average in the markets that we serve. Copyright 2017 Kaiser Permanente, Slide 10

11 Driving performance through incentives Permanente physicians are all salaried, based on competitive salaries in their specialties and geographic areas, and they 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 measures of quality, access, and service. Copyright 2017 Kaiser Permanente, Slide 11

12 Driving performance through incentives Many other groups (besides physicians) participate in an annual incentive plan tied to mission, vision, and strategy. This incentive plan provides an opportunity for an annual bonus payment based on individual performance as well as the Programwide achievement of key quality, membership, and financial measures. Labor union contracts may include group incentive plans. Copyright 2017 Kaiser Permanente, Slide 12

13 Kaiser Permanente HealthConnect Kaiser Permanente typically spends about 6% of our total revenue on information technology. Our integrated IT system for care delivery is called KP HealthConnect. 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 are currently signed up. In the U.S., a major health care IT achievement is to be at Stage 7 (paperless). Kaiser Permanente s hospitals and medical offices have achieved this. Copyright 2017 Kaiser Permanente, Slide 13

14 Percentile Our quality of care is up Performance relative to national benchmarks th 90 th 75 th th 25 th 10 th 04 Clinical effectiveness composite 04 Diabetes care composite Cardiovascular care composite 03 Prevention composite 03 Cervical cancer screening 04 Colon cancer screening Best care for chronic conditions Leading prevention & cancer screening Note: Placement of current status and starting points approximate Copyright 2017 Kaiser Permanente, Slide 14

15 Health care transformation Hospital with hospital-based 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 Tele-medicine Care anytime Copyright 2017 Kaiser Permanente, Slide 15 :: ::