The Kaiser Permanente Experience A Focus on Chronic Illness and Health Promotion and Wellness Initiatives Louise Liang, MD Senior Consultant, Kaiser Permanente The Global Knowledge Exchange Network April 2009

Kaiser Permanente as a leader Opened to the public in 1945, Kaiser Permanente is the largest nonprofit, integrated health care delivery system in the United States.

About Kaiser Permanente Nation’s largest nonprofit health plan Integrated health care delivery system 8.7 million members 14,000 physicians 165,000 employees Serving 9 states and the District of Columbia 36 hospitals and medical centers 416 medical offices $37.8 billion annual revenues (2007) 3 © Copyright Kaiser Permanente 3

Membership by Coverage Type Membership by Ethnicity Type Who Are KP Members? Membership by Coverage Type 85% Commercial Medicare 10.% Special Programs 3% Medicaid 2% Ages 0-19 28.7% 45-64 28% 20-44 33.2% 65+ 11.1% African American 9.6% Asian 8.6% Membership by Ethnicity Type 28.3% Hispanic 46.2% Caucasian 7.3% Other

A FOCUS ON CHRONIC ILLNESS INITIATIVES

The Care Management Institute 1997 - 2005 Developed in 1997 as a national KP organization jointly funded and managed by the Health Plan and the Permanente Medical Groups. Mission: “Making the right thing easier to do.” Identify the right things Evidence-based medicine Measurement Successful practices Make the right things easier Focus on the delivery system Technology to support effective work Networks of individuals and groups Initial focus was in the development of “world class” clinical practice guidelines for the organization and provide a laboratory for interesting clinical delivery problems.

The Care Management Institute 2005 + CMI promotes superior care for KP system-wide, improving care all the way to the member. We inform and enable KP in setting performance improvement priorities for population care, and we support Regions in achieving transformative health care through our integrated capabilities of care delivery improvement, analytics, and evaluation. Keeping patients at the center Harnessing technology Integrating capabilities across Kaiser Permanente Applying evidence Measuring results Spreading successful practices

Kaiser Permanente HealthConnect™ Lab Radiology/ Imaging Others (immunizations, EKG, dictation) Outpatient Pharmacy Health Plan Claims Processing Membership/ Benefits Benefits Accumulation Pricing System Web Access Portal Data Warehouse / EDR Enterprise Data Repository Ancillaries Referral & Utilization Management Finance Capital Planning General Ledger Financial Reporting Care Delivery Core Inpatient Scope of KP HealthConnect Suite Scheduling Registration Clinicals Billing Admission, Discharge and Transfer Health Information Management Emergency Department Operating Room

KP’s IT Infrastructure Data in our Electronic Medical Record enables: Direct patient care, documentation, and communication Communication with our Members Population Management Decision Support Panel Management and Performance Reporting Automated outreach Health Information On-Line targeted to patient health history and preferences Biomedical Device Integration

Kaiser Permanente HealthConnect™ Integrating health care across the continuum Inpatient & outpatient clinical care: Documentation, Ordering, Decision Support Hospital & outpatient practice management: Billing, Scheduling, Registration, ADT (admission, discharge and transfer) Ancillary systems: Pharmacy, Labs, Radiology, etc. Online access to personal health record: My health manager at kp.org 10 © Copyright Kaiser Permanente 10

Kaiser Permanente HealthConnect™ by the Numbers All 8.7 million members have the benefit of a complete or partial KP HealthConnect record Outpatient EMR available to all care teams 23 hospitals deployed end-to-end with complete KP HealthConnect suite Almost 3 million members actively using My Health Manager on kp.org Universal adoption by providers 6.1 million e-mails sent to providers in 2008 5.6 million prescriptions refilled online in 2008 16.8 million lab results viewed online in 2008 11

“Transforming & Streamlining Modalities of Care” By Catherine Chen, Terhilda Garrido, Don Chock, Grant Okawa, and Louise Liang, MD. Published in Health Affairs, March 2009. Deployed KP HealthConnect (EHR) and My Health Manager (PHR) in Hawaii region in 2005. Impact between 2004-2007. Annual office visit rate -26.2% primary care -25.3% specialty care -21.5% Scheduled telephone visits + 8 fold Secure e-mail messaging +6 fold to 51,000 in 2007 Total patient contacts +8.3 percent Quality and satisfaction maintained or slightly improved 12 © Copyright Kaiser Permanente

KP Clinical Content Access to library of KP knowledge and best medical practices at the point of care Tools and templates that facilitate the delivery of evidence-based medicine Dynamic decision-support tools that enhance quality and patient safety Drug-Drug Interactions Alerts Drug Allergy Alerts Best Practice Alerts Health Maintenance Reminders Alternative Order and Medication Alerts Patient education and tools to support self-care KP wanted basic approaches built-in that would enhance the consistency of care system wide. Because we are so large, we wanted to find ways to coordinate care – and decision making – from region to region. Chronic disease models take best practices from across the system – and the latest research – to establish protocols not only for chronic diseases, but also for almost any illness, making it all available at our physicians’ fingertips within a patient’s record. And we wanted our members to be able to learn more about how to improve their health – and stay healthy – easily, at home, at work, wherever. Bottom line: a user friendly computerized medical record supported by the full wealth of medical knowledge available.

Total Panel Ownership with KP HealthConnect

Panel support tool A primary care physician’s patients and their care gaps Execution

Whole panel views Vitals signs for the primary care team Execution

Round 2: Specialty Panels

Benefits of proactive specialty care Prevents late referral Improves preparation Improves appropriate referrals Slows progression to ESRN

A FOCUS ON WELLNESS INITIATIVES

KP HealthConnect™ kp.org and My Health Manager Integrated Clinical Information Systems Population Management Tool Labs Disease Registries Risk Stratification Patient management tools Targeted panel lists Inreach – Clinical prompts & reminders Outreach- Letters & Calls Continuous process improvement KP HealthConnect™ Secure Web-Based Universal Access Real Time Linked to delivery system Not claims-based Inpatient Outpatient Emergency Pharmacy Imaging Immunization Membership kp.org and My Health Manager Financial and Benefits L&T Forum Complete - Cappiello 07-11-06 OTN 29865 20 20

My Health Manager Web-based options are playing a larger role in doctor-patient interaction Patients who use secure e-mail were 7 to 10 percent less likely to schedule an office visit, and make about 14 percent fewer phone contacts than those not using online services E-mail is more convenient and efficient for both the physician and patient for non-urgent concerns. Improved Source: American Journal of Managed Care

My Health Manager – Member Benefits Secure view of EHR: View lab results, immunizations, allergies, past office visits Interact with care team: E-mail my doctor, complete a HRA Convenient transactions: Refill prescriptions, manage appointments, act for a family member Educational opportunities: Links to health & drug encyclopedias, online behavior change programs

KP.ORG KP HealthConnect allows members to send secure email, review lab results, medication lists, and other personal medical information via KP.org using a secure and password-protected Internet connection. At any time, day or night, members can schedule or cancel appointments, pay bills, request medication refills, and ask for referrals. Members’ personal health information will be seamlessly integrated into KP.org to help them better understand the care they're receiving - and build a stronger relationship with their KP providers.

Total Health Assessment

Positive Outcomes from Healthy Lifestyle Programs Members Weight Smoking Stress Pain Health Nutrition habits Management of diabetes Employers Productivity Health of workforce Presenteeism Spending

Additional Online Resources Over 20 Featured Health Topics from Asthma to Women’s Health In-depth information on over 4,000 topics Links to health calculators, complimentary care services, health videos, audio programs, recipes, and much more Detailed information on thousands of drugs Search directory of over 2,250 classes available across CA Much of the content and resources is available in Spanish

What KP will Deliver Tomorrow? Employers Additional tools & resources to promote employee health and productivity Members New features, tools, and content added to My Health Manager Streamlined access, personalized views KP HealthConnect™ Extend inpatient capabilities Leverage integration and information for complete care and population management