stepping up to total health

WE BUILD A BRIGHTER FUTUREtogether

Union Delegates Conference 2012March 24, 2012

Raymond J. Baxter, PhDSenior Vice PresidentCommunity Benefit, Research and Health Policy

Stepping Up to Total Health

Kaiser Permanente’s History

Our Mission for Generations: “To provide high quality, affordable health care,

and to improve the health of our members and the communities we serve”

Grand Coulee Dam - 1942 Grand Coulee Dam - 1942

*NCQA market ranking based on state boundary, and not KP regional market. SCAL and NCAL ranked first within each of its KP regional

markets, but second in NCQA state market only to each other.

HEDIS Measures 2011

NCAL SCAL HI NW CO GA MAS OH

Childhood Immunization Status – Combo 2 & 3

Chlamydia Screening in Women - Total

Appropriate Treatment for Children w/URI

Adult BMI Assessment

Weight Assessment for Children –

BMI Percentile

Comprehensive Diabetes Care –

Medical Attention for Nephropathy

KP REGIONAL MARKET RANKING

1 1 1 1 1 1 1 1

1* 1 1 1 1 2

1 1 1 1 1 1 1

1 1 1 1 1 2

1 1 1

1 1 1 1 1

1 1 1 1

1

1 1

Breast Cancer Screening 1*

1 1 1

1

1 1 1 1

1 1

1

1 1

1*

1*

1*

1*

1*

We’re #1…Market-leading Prevention

We’re #1…Market-leading Care

NCQA ranking of 341 Medicare health plans in US (2011)

KEY:1\ Medicare ranking out of 341 ranked health plans2\ Mid Atlantic ranked #1 for Medicare in VA, DC, and MD 3\ Northwest ranked #1 in OR and WA4\ Second only to the other KP plan in California

2

Northern California

Southern California

Colorado

Georgia

Hawaii

Mid Atlantic2

Northwest3

Ohio

KP Medicare RankingNational1 State

1

2

3

31

7

17

4

19

1

1

1

1

1

1

4

1

Pills, Knives, Devices and Gene Therapy Will Not Be Enough

We Must Address Health At All Levels

Deploying Kaiser Permanente Assets for Total Health

1Neighborhood /

Community

Society

Individual / Family

Home / School /Worksite

CommunityHealth

Initiatives

Environmental Stewardship

Clinical Prevention

Access to Social and Economical

Supports

Health Education

Public Education

WorksiteWellness

Public Policy

Research

Physical and Mental Health Care

Walking Promotion

Many Factors Shape Health

Health is driven by multiple factors that are intricately linked – of which medical care is one component.

Family Historyand Genetics

30%

Environmentaland Social

Factors20%

PersonalBehaviors

40%

Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993

MedicalCare

10%

Drivers of Health

Behaviors Shape Health

Actual Causes of Death in the U.S. in 1990 and 2000Actual Causes of Death in the U.S. in 1990 and 2000

*Data are from McGinnis and Foege. Percentages are for all deaths.*Data are from McGinnis and Foege. Percentages are for all deaths.

Actual CauseNumber (and %)

1990*Number (and %)

2000

Tobacco 400,000 (19%) 435,000 (18.1%)

Poor diet and physical inactivity 300,000 (14%) 400,000 (16.6%)

Alcohol consumption 100,000 (5%) 85,000 (3.5%)

Microbial agents 90,000 (4%) 75,000 (3.1%)

Toxic agents 60,000 (3%) 55,000 (2.3%)

Motor vehicle 25,000 (1%) 43,000 (1.8%)

Firearms 35,000 (2%) 29,000 (1.2%)

Sexual behavior 30,000 (1%) 20,000 (0.8%)

Illicit drug use 20,000 (<1%) 17,000 (0/7%)

Total 1,060,000 (50%) 1,159.000 (48.2%)

We Have to Disrupt Current Defaults…

What We’re Up Against

Change in price of items since 1978, relative to overall inflation, as measured by the Consumer Price Index. The price of carbonated drinks, for example, has fallen 34 percent relative to all other prices.

Source: Leonhardt, 2010


0

0.1

0.2

0.3

0.4

0 100 200 300 400 500

Minutes Spent in Car Per Day

Pro

ba

bil

ity

of

Ob

es

ity

White Male White Female

Black Male Black Female

Slide courtesy of Richard Jackson, MD


Interventions: Individual

We know what to do…

AdviseScreen ReferAssist

… we have the tools…

… and we need to do it with each and every member.

Interventions: Individual/Family

Smith, John W

Exercise As Vital Sign, Exercise Rx Tools, Tips, Motivation and Support

• Office-based

• Direct-to-member

• Online tools

• Cooking tips

• Recommend at least 150 minutes of moderate to strenuous exercise per week.

Interventions: Activity

Regular walking can prevent misery

of colds

Raises HDL

Aerobic exercise helps strengthen the heart, lungs,

and muscles

Helps people with diabetes to control their blood sugar

Reduces risk of oseteoporosis

and broken bones

Reduces the pain and swelling from arthritis

Improves mood and energy

Gain 1.3-1.5 healthy years of

life

Evidence of Short and Long Term Benefits

Interventions: Institutional

KP Farmers’ Markets Cafeteria menu labeling, KP Healthy Picks KP facilities as community assets Environmental stewardship Supplier diversity initiative

Interventions: Employers

We have begun to offer a portfolio of services that can help KP customers, prospects and other organizations improve the health of their workforce.

• Standard & customizable print/web communications• HealthWorks Workbook

CommunicationsLifestyle Telephonic

Health CoachingAnalytics & Reporting

• HealthMedia Reporting• Exercise Pgm.

Reporting• Rewards reports• Kp.org activity reports

• Inbound coaching

Interventions: Community Health

Healthcare• BMI as a vital sign• Breastfeeding promotion• Hospital cafeterias

Schools• Cafeteria reforms • PE standards, after school programs• Joint Use Agreements• Safe routes to school

Worksites• Stairwell prompts• Lactation support• Worksite wellness programs

Neighborhoods• Parks, trails and other active public spaces• General Plan amendments• Corner store conversion efforts• Farmers markets and community gardens

Neighborhoods

Schools

Worksites

Healthcare

20

www.communitycommons.org

Interventions: Getting to Scale

(1) Southern California

Kaiser Permanente Members With 150 Minutes or More of Exercise Per Week(1)

78.4%

41.0%36.0%

0%

20%

40%

60%

80%

100%

Age 12-17 Age 18-64 Age 65+

Current regional average = 43%

KP target = 100%

Less Than Half of the U.S. Population Meets Healthy People 2020 Objectives for Diet and Exercise

Source: BRFSS, 2007

Big Opportunities Exist for the U.S. and Kaiser Permanente

Support Individuals Encourage Groups

Change Communities Track Outcomes

4 Diseases, 4 Risk Factors* 4 Kaiser Permanente Actions

*Aligns with World Health Organization’s framework for monitoring non-communicable diseases

An Integrated Approach to Diseases and Risk Factors

A Total Health Portfolio

Total Health will require a coordinated set of activities, focusing on some key initial areas while developing core capabilities and enhancing efforts on work underway.

Total HealthFocus Areas

Healthy Schools

Workforce Wellness

Focus as first and relatively complete

demonstrations of Total Health, done

everywhere in KP

Core Capabilities“Fundamentals”

KP Integrated Care Model

Behavior Change strategies

Member Assistance Program

Effective Communications

Essential components needed to realize

Total Health

Applications of Total Health

Every Body/KP Walk!

The Weight of the Nation

HEAL/obesity prevention and treatment

Hypertension control

Disparities elimination

Work underway butTotal Health lens can help deepen the work

and re-double our efforts

Why Schools?

Vision: Schools Served by KP are the Healthiest Schools in America

* Draws from CDC Coordinated School Health, Alliance Healthy Schools Framework & WELCOA (Wellness Council of America)

What makes a healthy school?•Multi-component interventions

•Multi-stakeholder engagement

•Consultative support and technical assistance

1Neighborhood /

Community

Society

Individual / Family

Home / School /Worksite

Neighborhood & Community & School: Policy / Environmental Assets Cafeteria / vending

reforms Universal breakfast

PE standards Safe routes to school Joint Use Agreements

Photovoice School wellness

councils

Eligibility determination for federal nutrition programs

School: Student-Focused Assets Educational theatre KP volunteers Mentorship programs School-based health

centers Outreach / enrollment for

subsidized insurance TV turnoff

SPARK PE interventions Every Body Walk! School gardens Farm to school Fitnessgram PlayWorks

KP Is Already Delivering on Many Total Health Components for Schools, Their Staff and Students

Worksite: Staff -Focused Assets Consultative support to

create a wellness strategy

Biometric Screenings Health promotion classes Incentive programs Healthy lifestyle programs

FruitGuys Healthy Picks Toolkits Every Body Walk! Thrive Across

America 10,000 Steps

Individual / Family: Member-Focused Assets across the Health Continuum

Promoting Health Anticipating Health Risks Managing Chronic Conditions• Immunizations• Self-care tools & resources• Best-practice care• Proactive outreach• Referrals without pre-approval• Registry data tracks risk factors

• Preventive care: EVS & BMI and counseling• E-mail providers• Health education & promotion including classes for families• Online resources & telephonic coaching• Well child visits and sports physicials• Menu Labeling

• Comprehensive services for KP members

• Forty CHI sites integrate student health components at a local level

• Grantmaking, technical assistance and advocacy support district- and state- level change

• Employee wellness offerings are available to schools across KP through HealthWorks (~250 CA school districts)

Launch Fall 2012

Launch Fall 2013

Launch Fall 2013* Lower

Reach / Higher Intensity

* Higher Reach / Lower Intensity

Healthy Schools: Tiered Model for High Reach and High Impact

Offer a “KP Healthy Schools” tiered product available to all schools within Kaiser Permanente’s existing footprint. Leverage and integrate existing KP assets including HealthWorks, Community Benefit and the delivery system alongside a national partner.

Our Mission of Generations:“To improve the health of our members and the communities we serve”

KP’s Origins: The Health of the Workforce

Total Health Aspiration: KP Workforce is the Healthiest in Healthcare

Workforce Vision

KP workforce is productive, healthy, thriving, leading satisfied lives and fulfilled careers, committed to KP vision, highly skilled and engaged in

learning and improvement, creative, flexible, positive, resilient

Healthy Hospital Choices: Recommendations and Approaches from an Expert Panel

Food/Beverage

Physical Activity

Breastfeeding

Tobacco Cessation & Control

Dissemination & Surveillance

• Health sector and public health have an opportunity to address the nation’s chronic disease burden and health care costs by promoting healthy hospital food environments. • Healthy food is to be defined not only by nutrition standards but also by an economically & environmentally sustainable food system.• Current food environment measurement tools should be further adapted for hospitals.• Food policies should cover all venues, including cafeterias, vending machines, snack carts and gift shops.

• Health sector and public health have an opportunity to address the nation’s chronic disease burden and health care costs by promoting healthy hospital food environments. • Healthy food is to be defined not only by nutrition standards but also by an economically & environmentally sustainable food system.• Current food environment measurement tools should be further adapted for hospitals.• Food policies should cover all venues, including cafeterias, vending machines, snack carts and gift shops.

• Promote trails, public spaces and use of hospital facilities for physical activity opportunities.• Create policies that promote access to facilities and time for physical activity during all hospital shifts.• Connect physical activity strategies to emerging evidence and national efforts to combat obesity.

• Promote trails, public spaces and use of hospital facilities for physical activity opportunities.• Create policies that promote access to facilities and time for physical activity during all hospital shifts.• Connect physical activity strategies to emerging evidence and national efforts to combat obesity.

• Breastfeeding is encouraged by most major health agencies.• Hospitals are a unique setting in that they can support breastfeeding for employees, patients and visitors.• Hospitals should support breastfeeding by providing break rooms and time for expressing breast milk for employees and, where possible, for visitors.

• Breastfeeding is encouraged by most major health agencies.• Hospitals are a unique setting in that they can support breastfeeding for employees, patients and visitors.• Hospitals should support breastfeeding by providing break rooms and time for expressing breast milk for employees and, where possible, for visitors.

• Customary hospital practices and resistance from employees and patients who smoke may pose barriers to efforts to implement tobacco-free hospital campus policies, but these barriers can be overcome with careful planning and preparation.• A tobacco control model can incorporate Joint Commission performance measures and achieve a high level of compliance to effective policies and practices.• Coverage of tobacco cessation treatments varies by health insurance plan and availability of services varies across communities.

• Customary hospital practices and resistance from employees and patients who smoke may pose barriers to efforts to implement tobacco-free hospital campus policies, but these barriers can be overcome with careful planning and preparation.• A tobacco control model can incorporate Joint Commission performance measures and achieve a high level of compliance to effective policies and practices.• Coverage of tobacco cessation treatments varies by health insurance plan and availability of services varies across communities.

• Successful strategies to improve hospital environments include identifying partners, such as public health, with clearly defined wellness goals, tailoring messages and garnering executive endorsement.• Healthcare providers can be engaged as effective advocates to disseminate and make changes to nutrition and physical activity environments within their own institutions.• Demonstrating linkages to other hospital priorities and creating a recognition system is a key element.• A national assessment tool and indicators for large scale success will help in disseminating best practices.

• Successful strategies to improve hospital environments include identifying partners, such as public health, with clearly defined wellness goals, tailoring messages and garnering executive endorsement.• Healthcare providers can be engaged as effective advocates to disseminate and make changes to nutrition and physical activity environments within their own institutions.• Demonstrating linkages to other hospital priorities and creating a recognition system is a key element.• A national assessment tool and indicators for large scale success will help in disseminating best practices.

Healthy Eating

Healthy Eating

Healthy Physical Environment

Healthy Physical Environment

Healthy Activity at Work

Healthy Activity at Work

Workforce Wellness: Where to Start?

Workforce Wellness: “Champion” Level

Source: Dee Edington, Zero Trends: Health as a Serious Economic Strategy, Health Management ResearchCenter, University of Michigan, 2009Note: HERO, WELCOA, and NBGH models contain same fundamentals

Create the Vision

•Commitment to healthy culture

•Connect vision to business strategy

•Engage leadership in vision

•Leaders are held accountable

Align Workplacewith Vision

•Engage everyone

•Brand health management

strategies

•Integrate policies into culture

Create Winners

•Help employees not get worse

•Help healthy employees stay

healthy

•Provide improvement &

maintenancestrategies

ReinforceCulture of Health

•Reward champions

• Set incentives for healthy

choices

•Reinforce at every touch point

Outcomes Drive Strategy

•Integrate all resources

•Measure progresstowards goals in

first 4 pillars

•Strategic, Systemic,Systematic,Sustainable

Senior Leadership

Operations Leadership

Self Leadership

Reward Behavior

Quality Assurance

Fundamentals Required for Transformation to Champion Level

Kaiser Permanente has assumed a leadership role in promoting the power of walking

Collaborative development of two dynamic online programs: For Kaiser Permanente Employees: KP Walk!

Get Involved: www.KPWalk.com

For All Americans: Every Body Walk! Get Involved: www.EverybodyWalk.org

We Have to Engage People in the Solutions

We Have Become the Benchmark

May 2012May 2012

The Road Ahead is Challenging…But We Can Find A Way

stepping up to total health

Documents