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

2. 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

3. 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

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

5. 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

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

7. 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

8. 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

9. 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.

10. 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.

11. 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.

12. 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

13. Areas of Focus
Care Management
Information Technology

14. 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

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

16. 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.

17. 10 Clinical Priority Areas
KP Members Clinical Area with this Condition
Asthma 141,000
Coronary Artery Disease 256,000
Depres sion ,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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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 ( , web, phone)
Chronic disease management models
Supports for patient self-care
Open access scheduling systems
Enhanced research capability

24. Kaiser Permanente
People
Understanding
Health