Benjamin K. Chu, MD, MPH President Kaiser Permanente Southern California Great Gains in Quality of Care and Patient Safety: The Kaiser Permanente Experience
The triple aim : A blueprint for a more satisfying future? Improving the health of our population p Improving the care experience Focus on value and cost efficiency
Founded in 1945, Kaiser Permanente is one of the nation s largest nonprofit health plans serving more than 8.8 million members in eight regions across the country Kaiser Permanente s capitated payment model places equal emphasis on keeping people healthy and caring for members when they are ill. A Snapshot of Kaiser Permanente 8.8 million members 35 hospitals 431 medical offices 15,000 physicians 167,000 employees $45 billion annual revenue $4 billion health information technology investment 60 years of providing care Focus on prevention of illness and disease Focus on improving community health helps our members and patients
Kaiser Permanente s Integrated System Connects Health Plan and Health Care Services KAISER FOUNDATION HOSPITALS HEALTH PLAN MEMBERS KAISER FOUNDATION HEALTH PLAN Southern California PERMANENTE MEDICAL GROUP Kaiser Permanente has integrated finance and care delivery services This creates the ability to allocate resources where needed to achieve the best health outcomes for the patient Kaiser Permanente s capitated payment model places as much emphasis on keeping people health as it does on caring for members when they are ill.
Key Drivers of Quality and Service Improvement Actionable, real time information through electronic tools Absolute transparency of results a mirror on organizational and individual performance Benchmarks Cultural change efforts
Kaiser Permanente Clinical Information Systems provide better patient management using evidence-based medicine Labs Hospital Pharmacy Outpatient Appointments Outpatient ti t Encounter Membership Emergency Department Immunizations i Clinical Information Systems Registries Risk stratification of population Identify subgroups needing specific care Patient management tools Targeted panel lists Prompts, reminders for clinicians Letters and automated telephone outreach to members Monitoring and process improvement measures and reports Targeted health education and self-care support
Kaiser Permanente s Registry for Chronic Diseases and Panel Management can be used for physician panel management Care team members can access registry and panel management tools to help address care gaps
Proactive encounters at every point of contact have revolutionized how Kaiser Permanente provides total health Pre-Encounter Office Encounter (proactive Vital sign collection identification) and documentation Identify missing labs, Identify and flag alerts screening for provider procedures, access Room and prepare management, kp.org patient for necessary status, etc. exams Provide member Pre-encounter follow instructions before up visit Contact member and document encounter in Kaiser Permanente HealthConnect Post Encounter Immediate: after- visit summary, after care instructions, follow-up appointments, Health Education materials, how to access kp.org Future: follow-up contact and appointments per provider Back Office Support Letters E-mail Inbox Management All staff have responsibility for patients total health. Not all patients t see their primary care physician. i Every office encounter has been redesigned to optimize each patient contact. Areas of need are identified and acted on.
Outcomes in Kaiser Permanente Southern California for better total health Using its information technology tools, Kaiser Permanente Southern California has improved almost all major measures, including breast, cervical, and colorectal screenings; controlling high blood pressure, and osteoporosis management 90% 80% 70% 60% 50% 40% Breast Cancer Screening (52-69) Cerv ical Cancer Screening Colorectal Cancer Screening Controlling High Blood Pressure (Ages 18-85) Osteoporosis Management in Women Who Had a Fracture YE 2005 YE 2006 YE 2007 YE 2008 YE 2009 YE 2010
Patient safety measures have improved steadily over the last few years and outperform some national measures Hospital-Acquired Pressure Ulcers TJC Core Measures 8% 100% 7% 95% 6% 90% 5% 85% 4% 80% 3% 2% 1% 0% 75% 70% 65% 60% 4Q10 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10 3Q10 KPSC HAPUs, All Stages CalNOC Average AMI Bundle HF Bundle CAP Composite SCIP Composite 1.6 Blood Stream Infections Mortality Rates 0.80 1.4 1.2 0.75 1.0 0.70 0.8 0.65 0.6 0.4 0.60 0.2 0.55 0.0 0.50 4Q10 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 4Q 10 1Q 11 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10 3Q10 KPSC ICU BSI Rate NNIS BSI Rate Average US Medicare Overall KPSC
Hospital infection control improvements Urinary Tract Infections ICU Hospital v. Community Acquired Clostridium - Difficile 4.0 30.0 ter days rates per 1000 cathet CAUTI 3.5 30 3.0 2.5 2.0 > 1.5 1.0 0.5 KPSC CAUTI Rate National Adult ICU Benchmark Rate per 10,000 patien nt days C-Diff 25.0 20.0 15.0 10.0 5.0 > KPSC Hospital Acquired C-diff Rate Community Acquired Rate 0.0 1Q 10 2Q 10 3Q 10 4Q 10 1Q 11 0.0 1Q 08 2Q 08 3Q 08 4Q 08 1Q 09 2Q 09 3Q 09 4Q 09 1Q 10 2Q 10 3Q 10 4Q 10 1.4 Blood Stream Infections Med/Surg Blood Stream Infections NICU 7.0 BSI rates per 10 000 line days 1.2 1 0.8 > 0.6 0.4 0.2 0 KPSC Non-ICU CLABSI rate National Benchmark - Non ICU med/surg 1Q 10 2Q 10 3Q 10 4Q 10 1Q 11 BSI rate per 1,00 00 line days 6.0 5.0 4.0 3.0 2.0 1.0 0.0 > KPSC BSI-NICU NHSN BSI NICU Benchmark 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 07 07 07 07 08 08 08 08 09 09 09 09 10 10 10 10 11
Clinical strategic goals benefits achieved (lives saved) 2004 October 2010 Metric Increase Savings Per Decade Cholesterol Control 22.5% 1807 Lives Blood Pressure Control 41.8% 5739 Lives HbA1C < 9.0 12.5% 1182 Lives Smoking cessation 17.0% 1011 Lives Breast Cancer Screening 11.5% 575 Lives Cervical cancer screening 5.8% 58 lives Colon cancer screening 29.8% 4724 lives Total: 15,096 lives
HCAHPS inpatient service scores are amenable to similar interventions Rate Hospital (9-10) All Inpatient Combined March 2007 vs. May 2011 HCAHPS: Rate hospital (9-10) - All IP Combined HCAHPS: Rate hospital (9-10) All IP Combined Month of May '11 10th 25th 50th 60th 75th 85th 90th BM: CMS National Benchmark Based on Reporting Period 2009 Q1-2009 Q4 55.0 61.0 66.0 68.0 0.0 72.0 75.0 78.0 SCAL Facility March 2007 May 2011 10th 25th 50th 75th 85th 90th Irvine NA 83.7 83.7 Downey 56.0 83.4 56.0 83.4 Panorama City 42.4 79.9 42.4 79.9 Los Angeles 50.3 77.2 50.3 77.2 Baldwin Park 61.6 74.9 61.3 74.9 Anaheim 57.4 73.3 57.4 73.3 Woodland Hills 50.3 72.8 50.3 72.8 West LA 53.7 72.5 53.7 72.5 Riverside 39.5 70.6 39.5 70.6 South Bay 54.3 69.5 54.3 69.5 Moreno Valley NA 69.4 69.4 San Diego 44.2 68.1 44.2 68.1 Fontana 51.0 65.9 51.0 65.9 KP Southern Re 50.4 73.9 50.4 73.9
Outcomes: Hip fractures decreased by almost 40% due to proactive measures 37% total reduction in hip fractures in older women Hip fractures in older women lead to many complications including: Lack of mobility Inability to provide selfcare Expensive nursing home care Death