an overview of kaiser permanente - integration and information systems in health care

An Overview of Kaiser PermanenteIntegration and Information Systems in Health CareJuly 2014

Molly Porter, Director, Kaiser Permanente [email protected], kp.org/international

Copyright © 2014 Kaiser Permanente

mailto:[email protected]

What is Kaiser Permanente?

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as the largest integrated delivery system in the U.S. and one of the leading health care providers and not-for-profit health plans.

Our strategy is to excel in providing high-quality, affordable health care through our integrated delivery system, our investment in technology, and our vision of supporting Total Health.

Copyright © 2014 Kaiser Permanente, Slide 2

Our 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: To be a leader in Total Health by making lives better.


Kaiser Permanente Hospitals are the safest in

the nation

10 Kaiser Permanente Hospitals listed among the nation’s elite in annual “Best Hospitals” rankings

All Kaiser Permanente regions received 5-Star ratings, the

highest possible rating

Kaiser Permanente is the only health plan in California to earn

the highest rating for overall quality of care in the Healthcare

Quality Report Card

Kaiser Permanente has received 36 Stage 7 Hospital Awards for

successful electronic health record implementation

Leads the nation in the most No. 1’s in Effectiveness of Care

Measures

Kaiser Permanente is recognized nationally

The KP flagship and Every Body Walk! apps have received Silver

Web Health Web Awards recognizing high-quality digital

resources for consumers

KP won five 2013 eHealthcare Leadership awards, including

the highest honor for Organizational Commitment,

and the 2013 Hospital Website Transparency Award with

Distinction

KP’s California health plans receive top rating -- 4 Stars --

for quality and service

27 Kaiser Permanente facilities honored as ‘Top Performer’ for Quality and

Safety by The Joint Commission


KP by the Numbers

� 7 regions serving 8 states and the District of Columbia

� More than 9.3 million members� More than 17,000 physicians and 174,000

employees (including 48,000 nurses)� 38 hospitals (co-located with medical

offices)� 608 medical offices and other outpatient

facilities� 70 years of providing care (opened in 1945)


Our Markets and Membership: 12/31/2013

Georgia251,827

members

Mid-Atlantic States

502,176members

Colorado572,748

members

Hawaii229,304

members

California 7,252,462 members

Northwest501,547

members


External Validation of our Overall Quality

� In the National Committee for Quality Assurance’s 2013 Health Insurance Plan Rankings, all 8 Kaiser Permanente commercial plans were rated in the top 6% of the 484 ranked national plans.

� According to the 2014 Medicare star quality ratings: all 7 of Kaiser Permanente’s regions received 5 stars, based on 55 measures of quality and service, such as staying healthy, managing chronic conditions, member satisfaction, customer service, and pharmacy services.


External Validation of our Inpatient Care

� On four sets of Joint Commission inpatient process measures (related to heart attack, heart failure, pneumonia, and surgical care improvement), almost all Kaiser Permanente hospitals score in the top 10th percentile.

� We had the highest scores of any hospital system from The Leapfrog Group, which rates 2,618 hospitals on safety.


And our members like us!


Driving Performance through Incentives

� Permanente physicians are all salaried, based on competitive salaries in their specialties and geographic areas, and receive generous benefit packages.

� A small incentive bonus (usually less than 10%) is awarded if both the facility (practice site) and the individual physician achieve some specific quality measures


Driving Performance through Incentives

Physicians have goals related to:

� Quality

� Access

� Service

at the individual, department, and facility levels.

Their performance in these areas compared to local and regional averages affects their bonus as well as their annual pay raise.


Sample Quality Goals

� Childhood immunizations

� Breast cancer screening

� Chlamydia screening

� Tobacco counseling

� Diabetes glycemic control

� LDL control

� Blood pressure control


Kaiser FoundationHealth Plan,

Inc.

Permanente Medical Groups

Regions

The Permanente Federation,

LLC

Articles of Federation

Kaiser Permanente

Program Group

Medical Service Agreements/

Memorandums of Understanding

Kaiser Permanente +

Our Structure

13 Copyright © 2013 Kaiser Permanente, Slide 13

Kaiser Foundation Health Plan

POPULATION

Kaiser Foundation Hospitals

Permanente Medical Group

Health Plan Members

Medical Service Agreement

Hospital Service Agreement

Group/Individual Contracts: Prospective Payment

Operating Budgets Capitation to the Group

REVENUEEXPENSE

---------------------------------------------------------------------------------------------------------------------

KP Operating Model (since 1955)KP Operating Model (since 1955)


One-Stop Shopping for Most Services�Ambulatory/outpatient care�Audiology and optometry (hearing and seeing)�Behavioral/mental health�Diagnostic imaging, laboratory, and pharmacy�Emergency care and hospitalization*�Health education and preventive care�Home health care�Labor and delivery�Occupational health (workers’ compensation)�Physical therapy�Primary care working closely with specialty care, surgeons, hospitalists*

* Special note: In our smaller regions, we may contract with community hospitals as well as for some medical care.


KP leads the world with 100% adoption of Multifunctional Electronic Health Records

Doctors with EHRs and Multifunctional Health IT Capacity

97% 92%98%

69%

56%

82%

98%

68%60%

33%27%

10% 7% 4%0%

20%

40%

60%

80%

100%

120%

UK AUS NETH USA CAN GER NORSource: Commonwealth Fund 2012 International Health Policy Survey

Perc

enta

ge o

f Prim

ary

Care

Doc

tors

Using EHRs

with Multifunctional Health IT Capacity


External Validation of our IT Leadership

� The Healthcare Information and Management Systems Society (HIMSS) — the largest health care IT association in the world — gave us their top award, the Davies Award for health care IT excellence.

� Their top award for hospital IT achievement is to be a Stage 7 hospital. All Kaiser Permanente hospitals are Stage 7.

� Implemented between 2004 and 2010, KP HealthConnect is one of the largest and most advanced civilian deployments of an electronic health record.


Specialty Hubw/ primary care

Primary care / ancillaries

Mobile Services

Employer Clinics

Web

CareAnywhere

Tele-medicine

Micro-Hospital

Hospital w/ hospital based specialty care

Home as the Hub

Mobile Health

Health Care Transformation

:: ::

CareAnytime

Micro-Clinics


Kaiser Permanente typically spends about 6% of our total revenue on information technology. KP HealthConnect (our integrated system for care delivery) is:

Kaiser Permanente HealthConnect

� More than just an electronic medical record� A Program-wide system that integrates the clinical record with appointments,

ancillary and specialty services, registration, and billing� A complete health care business and management system that enhances the

quality of patient care� A personal health record for more than 4 million Kaiser Permanente members

(67% of members over 13 with Internet access)Note: Return on investment was estimated at 8.5 years (but this was a

strategic investment, not based on ROI)


Disease registries

Risk stratification

Identification of subgroups needing care

Patient management tools

Targeted panel lists

Inreach- prompts, reminders for clinicians

Outreach- Letters and automated telephone outreach to members

Monitoring and process improvement measures and reports

KP Health Connect

Secure Web-BasedUniversal AccessReal TimeLinked to Delivery SystemElectronic OrderingDigital ImagingSecure Messaging

CarePointPopulation

Management Tool

At Kaiser Permanente, patient care is highly coordinated through state-of-the-art technology and multispecialty physician group practice.

Labs

Inpatient

Outpatient

Emergency

Pharmacy

Imaging

Immunization

Membership

Financial &Benefits

KP.org and My Health Manager

Integrated Clinical Information Systems

KP Health Connect enables member engagement, which produces superior medical outcomes.


Instant Access to Medical Records for Providers and Patients

� Review medical records� Check lab results� Immunization records� History of medical visits� Direct ordering of

prescriptions, labs, and referrals

� Best practice alerts


56% of U.S. adult cell phone owners have smartphones.

Of the KP members registered on kp.org, a quarter of them are accessing our online features via mobile devices.

KP app:� locate facilities� access medical records� refill prescriptions � make appointments � email caregivers � view test

Anytime, Anywhere Access


Transforming Primary Care Encounters

5%16% 17% 17% 17% 16% 16%

18%23% 26% 28% 30% 33%

95% 66% 60% 57% 55% 54% 51%

0%

20%

40%

60%

80%

100%

2003 … 2008 2009 2010 2011 2012 1H2013

Office Visits

Secure email

Telephone

— KP Program Wide —

Source: UCDA Core Value Metrics

Care is not just delivered in face-to-face visits now. It is now done on the phone and through secure emails. In 2003, there were essentially 0% secure emails – Now it represents 32% of the primary care patient encounters.

24Copyright © 2014 Kaiser Permanente, Slide 24

Seniors are some of our highest online users!

% of KP members registered for kp.org at end of 2012Internet use not considered in this calculationKaiser Permanente Web Insights National Market Research

49%

66%62% 63% 66%

53%

18-29 30-39 40-49 50-59 60-69 70+


As a result, malpractice cases are down

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Professional Liability Claims Per 100,000 Members

KP HC implementation

began 2004


Preserving the Environment

Online requests contribute to an estimated annual 7,000 tons of avoided carbon dioxide emissions.

Health Affairs, 30, no. 5, 2011


“Ordering prescriptions online has made my life a lot easier no more driving 22 miles and waiting in long lines.”


Better Adherence

Patients (who used online prescription service) had higher rates of medication adherence as compared with nonusers.*

American Journal of Managed Care, 2012

*45% of all KP pharmacy refills are ordered online.


“The test result feature helps me to

be aware of my responsibility in taking

care of myself.”


More Loyal Members

Patients with online access to key components of the electronic health record’s patient portal, My Health Manager, are 2.6 times more likely than nonusers to remain Kaiser Permanente members.

The American Journal of Managed Care, July 2012.


“Kp.org is an excellent way to communicate with my doctor and children’s pediatrician. It saves me a lot of time.”


Panel Support Tools


Why Data is Critical to Health Care…All About the Outcomes

Convenience / Service Affordability Quality

14.8million

secure physician & clinician emails

131million

visits to KP.org & KP Mobile

3.6 online appointments

reductionin office visits per member

8%reduction

in follow-up visits per member

11% in emergency room visits

26%reduction

in medication errors

50%fewer

hospitalizations for diabetics

73% in cardiac mortality

57%

million reduction reduction


KP International Offerings (see kp.org/international)

April 14-17 : Three-day program in San FranciscoThree-day programs at Kaiser Permanente (currently planning for April 2015)

Presentations or seminars in your country

Care Management

Videoconferences or Skype presentations

Kaiser Permanente workshops or presentations in your countryTwo-day customized programs (for a minimum group size of 10)


an overview of kaiser permanente - integration and information systems in health care

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