Kaiser Permanente

Benjamin K. Chu, MD, MPH

President

Kaiser Permanente Southern California

Great Gains in Quality of Care and Patient Safety:

The Kaiser Permanente Experience

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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

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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

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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.

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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