Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

Structure & Key Features History Comparison To NHS & US Plans Overview Mission Structure & Key Features History Comparison To NHS & US Plans Areas Of Focus Care Management Information Technology

America’s Largest Non-Profit Health Care Program Integrated health care delivery system 30 hospitals and medical centers 431 medical offices $22.5 billion annual revenues 8.4 million members 134,000 employees 8 regions serving 9 states and D.C. 11,000+ physicians

Our Mission To provide high quality, affordable health care services and to improve the health of our members and the communities we serve.

A Prepaid Integrated Delivery System With Aligned Incentives Social Purpose Quality Driven Shared Accountability for Program Success Integration along Multiple Dimensions Prevention & Care Management Focus Permanente Medical Group Health Plan Members Kaiser Foundation Hospitals Kaiser Foundation Health Plan

Kaiser Permanente Partnership Kaiser Foundation Health Plan & Hospitals Permanente Medical Group Common Vision Exclusivity Joint Governance & Decision-Making

A Brief History 1933: Dr. Garfield’s prepaid health plan in the California desert 1938: 6,500 workers at the Grand Coulee Dam, Washington 1942: Kaiser shipyards in Richmond,CA; Vancouver, WA; and steel mill in Fontana, CA 1945: Membership opened to the public 1948: The Permanente Medical Group founded 1955: The Tahoe agreement, roles of PMGs and KFHP set

A Brief History 1997: The Labor Management Partnership (LMP) was forged and ratified by 26 AFL-CIO unions. It is the largest and most complex health care partnership in the United States - both operationally and in scope. 1958: Hawaii added as 4th region 1969: Colorado and Ohio regions added 1980: Mid-Atlantic region added through acquisition 1985: Georgia region started 1998 Care Management Institute started 1999: Commitment to implement common automated medical record - HealthConnect

Comparing KP and NHS In many ways KP is like the NHS, providing a similar range of services for a population equivalent to that of a small country. KP is roughly the same age as the NHS. Unlike the NHS, Permanente physicians cannot work outside the system. Feachem, et. al., BMJ January 19, 2002 Unlike the NHS, KP does not serve the entire population of a geographic area but rather operates in a competitive environment.

America’s Health Dollar, CY 2000 Medicare, Medicaid, and SCHIP account for one-third of national health spending. CMS Programs 33% Total National Health Spending = $1.3 Trillion 1 Other public includes programs such as workers’ compensation, public health activity, Department of Defense, Department of Veterans Affairs, Indian Health Service, and State and local hospital subsidies and school health. 2 Other private includes industrial in-plant, privately funded construction, and non-patient revenues, including philanthropy. Note: Numbers shown may not sum due to rounding. Source: CMS, Office of the Actuary, National Health Statistics Group.

Health Plan Enrollment by Plan Type, 1988-2001 Over the 1990s, managed care grew dramatically. Source: Employer Health Benefits, 2001 Annual Survey, The Kaiser Family Foundation and Health Research and Educational Trust. Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.

Northern California Member Demographics Total Membership: 3.2 Million Age 12%: 65+ Coverage 28%: 0-19 25%: 45-64 2%: Medi-Cal 11%: Medicare 35%: 20-44 87%: Commercial Ethnicity 4%: Other 66%: Caucasian 12%: Asian 7%: African American 11%: Latino

Areas of Focus Care Management Information Technology

Costs are not evenly distributed Distribution of Annual Health Care Spending Across Entire US Population 2000 Cost of Healthcare Source: Lewis 2000 Percent of Population

The traditional cost “iceberg”... Employees $$$ 65% 10% 40% 29% 5% 50% Distribution of total commercial population Costs associated with each segment Source: 2001 Northern California, Group XYZ Commercial Membership; DxCG methodology.

Chronic Illness Drives Medical Care Costs People $$$ 6% Those w/multiple chronic conditions 33% 31% 21% Those w/one chronic condition 36% 72% Those w/no chronic conditions Costs associated with each segment Segments within the total population Source: Kaiser Permanente Northern California commercial membership, DxCG methodology, 2001.

10 Clinical Priority Areas KP Members Clinical Area with this Condition Asthma 141,000 Coronary Artery Disease 256,000 Depres sion 411,000 Diabetes 577,000 Heart Failure 94,000 Cancer 25,000 new cases/yr Chronic Pain ~1,000,000 Elder Care 917,000 Obesity ~25% of adults Self Care 8.4MM

Population Management: More than Care & Case Management Targeting Population(s) Redesigning Processes Measurement of Outcomes & Feedback Intensive or Case Management Assisted Care or Care Management Usual Care with Support Level 1 70-80% of a CCM pop Level 2 High risk members Level 3 Highly complex members

Strategy: Make it easier to do the right thing... Identify the right thing Define evidence-based medicine Identify successful practices Leverage measurement to guide performance improvement Make the right thing easier Embed guidelines within systems to support practice Implement effective and innovative models of care Support teams of professionals to care for members Leverage technology to support population-based care

Information Technology Diverse current capacities Disease registries Notes and prompts Order entry Results reporting New system of computerized support tools Opportunity to re-engineer care

Kaiser Permanente HealthConnect More than just an electronic medical record A sophisticated information management and delivery system A program-wide system that will integrate the clinical record with appointments, registration and billing A complete healthcare business system that will enhance the quality of patient care and support the KP Promise

Our Entire Organization is Impacted Web Access Portal Care Delivery Core Ancillaries Health Plan Scope of KP HealthConnect Suite Outpatient Inpatient Membership/ Benefits Scheduling Scheduling Outpatient Pharmacy Registration Registration Lab Claims Processing Clinicals Clinicals Radiology/ Imaging Billing Benefits Accumulation Pharmacy Others (immunizations, EKG, dictation) Billing Pricing System Emergency Department Data Warehouse / EDR Enterprise Data Repository

KP HealthConnect Delivers Approaches to advanced care planning (simple registries, reminder systems, protocols) Coordination across sites of care (patient is identified throughout system, locations) Shared decision-making tools Multiple points of contact (email, web, phone) Chronic disease management models Supports for patient self-care Open access scheduling systems Enhanced research capability

Kaiser Permanente People Understanding Health