1. 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

2. 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.

3. 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

4. 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

5. A FOCUS ON CHRONIC ILLNESS INITIATIVES

6. 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.

7. 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

8. 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

9. 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

10. 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
© Copyright Kaiser Permanente 10

11. 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 s sent to providers in 2008
5.6 million prescriptions refilled online in 2008
16.8 million lab results viewed online in 2008 11

12. “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 Impact between
Annual office visit rate %
primary care %
specialty care %
Scheduled telephone visits + 8 fold
Secure messaging +6 fold to 51,000 in 2007
Total patient contacts percent
Quality and satisfaction maintained or slightly improved
© Copyright Kaiser Permanente

13. 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.

14. Total Panel Ownership with KP HealthConnect

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

16. Whole panel views Vitals signs for the primary care team
Execution

17. Round 2: Specialty Panels

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

19. A FOCUS ON WELLNESS INITIATIVES

20. 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 OTN 29865 20 20

21. My Health Manager
Web-based options are playing a larger role in doctor-patient interaction
Patients who use secure 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
is more convenient and efficient for both the physician and patient for non-urgent concerns.
Improved
Source: American Journal of Managed Care

22. My Health Manager – Member Benefits
Secure view of EHR:
View lab results, immunizations, allergies, past office visits
Interact with care team:
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

23. KP.ORG
KP HealthConnect allows members to send secure , 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.

24. Total Health Assessment

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

26. 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

27. 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