The document discusses how Kaiser Permanente improves health care quality through integrated teams. It describes Kaiser Permanente's model of providing comprehensive, high-quality and affordable care through integrated multi-specialty medical groups and hospitals. The model is enabled by a fully integrated electronic medical record system and performance measurement tools that support coordinated, population-based care and continuous quality improvement.
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Improving Health Care Quality Through Integrated Teams
1. Improving Health Care Quality
Through Integrated Teams
WoHIT Barcelona March 17, 2010
Hal Wolf
Sr. VP COO
The Permanente Federation, LLC
2. Health Care’s Common Challenges
Access to / timeliness of care
Costs
Quality gaps and variation – overuse, underuse,
misuse
Increasing prevalence of chronic diseases
Need for improved coordination across “system”
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3. About Kaiser Permanente
• Nation’s largest nonprofit health plan
• Integrated health care
delivery system
• 8.6 million members
• 14,600+ physicians
• 167,000+ employees
• Serving 9 states and the
District of Columbia
• 35 hospitals and medical centers
• 431 medical offices
• $40.3* billion annual revenues
* 2008 revenues
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6. IOM’s Six Major Challenges
“Organizations will need to negotiate
successfully six major challenges.”
Redesigned care processes based on best evidence
Effective use of information technology
Knowledge and skills management
Development of effective teams
Coordination of care across conditions, services, and
settings
Use of performance and outcomes measurement for
continuous improvement and accountability
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7. Growing Consensus About
Ideal Care
Accountable Care Organizations
Provides (or can effectively manage) continuum of care as a real
or virtually integrated local delivery system
Sufficient size to support comprehensive performance
measurement
Patient-Centered Medical Home
Personal physician
Physician directed medical practice
Whole person orientation
Care is coordinated and/or integrated
Quality and safety
Enhanced access to care
Payment that supports coordinated, comprehensive care
supported by information and communication technologies
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8. Guided by Mission and History
The Kaiser Permanente Mission:
To provide affordable, high-quality
health care services to improve the
health of our members and the
communities we serve.
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9. Role of Communities
Healthy communities
and a healthy
environment are
critical to individual
health and wellness,
but there is a disparity
in what we fund.
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10. The Physician Role Changes
The Traditional Model One Patient at a time
of Care Only Know about patients who
appear in your office
No use of IT
Limited use of extenders
New Model Elements Accountability for
panel/population
Transparency
Use of EMR, registries,
internet
Moving care out of the Dr. office
11. Panel Management
Population Care Management. Born from the development of Registries.
$ 6 million/year
0
2000+
CVD
DC
HTN
15% Panel 85%
12. Standard Patient Categorizing
Primary Secondary Acute Chronic
Patient
Sort
Standard
Complex Known
Dx
Sort Standard
Dx Process
13. Integration
Integration along multiple dimensions
Financing and medical care
Primary care, specialty care, ancillary providers, and ancillary
diagnostic and therapeutic services
“Continuum of care”-home, provider office, hospital , nursing
home/SNF
Continuum of an illness-primary and secondary prevention,
diagnosis, treatment, chronic care management and follow-
up, supportive care, and palliative care
Integration over time
14. Key Success Factors
Clear, agreed upon, mission
Strong, dedicated leadership
Aligned structure and incentives
Integrated information technology and performance
improvement
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15. Supported by Structure and Incentives
Compensation structure support aligned incentives and
shared accountability
Multispecialty medical groups enable coordinated care
Interdisciplinary care teams support spectrum of patient
needs across conditions, services, and settings
Integration encourages population perspective and
commitment to resource stewardship
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16. Enabled by Information Technology
and Performance Measurement
Fully functioning, fully integrated EMR
Kaiser Permanente HealthConnect
My Health Manager
Frequent, ongoing use of performance and outcomes
measures for continuous improvement and
accountability
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