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Panel Management — Update and Future Directions  Robert Unitan, MD, Kaiser Permanente Northwest  Brian J. Lee, MD, Kaiser Permanente Hawaii.

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Presentation on theme: "Panel Management — Update and Future Directions  Robert Unitan, MD, Kaiser Permanente Northwest  Brian J. Lee, MD, Kaiser Permanente Hawaii."— Presentation transcript:

1 Panel Management — Update and Future Directions  Robert Unitan, MD, Kaiser Permanente Northwest  Brian J. Lee, MD, Kaiser Permanente Hawaii

2 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 2  The 1:1 visit alone leaves primary care unsustainable – Donald Berwick, MD We Need to Do Things Differently….

3 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 3 Goals of Total Panel Ownership  To use evidence-based medicine to improve the health of the members we serve.  To support primary care physicians and health care teams by providing them with population care management tools and help them organize their work around KP's national priorities.

4 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 4 Enterprise Data Warehouse (EDW) Claims Membership Ancillary PCM Capabilities Leverage data from KP HealthConnect to provide the backbone for panel management capabilities Panel Management and KP HealthConnect

5 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 5 Panel Ownership and Complete Care

6 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 6 Specific Treatment Recommendations

7 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 7 All PST Data is Refreshed Nightly

8 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 8 Birthday Outreach for All Members

9 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 9 Sort by Contact Modality or Utilization

10 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 10 Monthly Performance Feedback

11 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 11 KPNW DM Screening—2007 HEDIS Effectiveness of Care Measure Q4 20062006 HEDIS 90 th Percentile Q4 2007 DM HBA1c Screening 90.8%92.7%93.5% DM LDL Screening 85.4% 90.9% DM Retinopathy Screening 69.6%69.3%75.3% DM Nephropathy Screening 89.4%91.2%92.6%

12 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 12 A.L.L. for DM and CVD (n=45K) Q4 2006TargetQ4 2007 ASA + Statin + Lisinopril 47.3%50.8%55.7%

13 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 13

14 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 14 Single Sign-On

15 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 15 Lessons Learned  Tool Development  Rapid Iterative process valuable  Small group that is responsible for development, quick decisions  Operational  Don’t underestimate the human factors on change—it’s only a tool  Investing in your end-users  Training  User feedback

16 Panel Management— Update and Future Directions  PART 2  Brian J. Lee, MD  Kaiser Permanente Hawaii

17 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 17 Primary Care — Panel Management Specialty Care — Panel Management Primary Care — Population Management Specialty Care — Population Management Types of High-Level Care

18 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 18 Twelve PCPs, Twelve Panels

19 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 19 Twelve PCPs, Twelve Panels... Add a Disease Red=referred Orange=unreferred

20 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 20 Twelve PCPs, Twelve Panels... and a Specialist

21 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 21 Population Management—CKD at KPHI  Seeing Nephrologist—1,000  Kidney disease—15,000  Member population—210,000

22 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 22 Panel Management vs. Population Management

23 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 23 Who Needs to See a Specialist? Those whose risk, due to a particular disease, can be substantially better managed by a specialist than a generalist.

24 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 24 A Change in How We Think About Referral  Specialists can judge better (vs. generalists) whom should be referred  Specialists should be more “hands-on” in deciding who makes up the subpopulation that they should be seeing  Specialists should recruit high-risk referrals, block inappropriate referrals, and send back low-risk patients to Primary Care

25 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 25 Panel Management vs. Population Management

26 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 26 Population Management  Active Management of Referrals  Development of evidence base to stratify risk  Solicitation of high-risk referrals  Returning low-risk referrals to Primary Care  Monitor for systemic deficiencies in care  Intervention without requiring referral

27 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 27 Population Management—Needs  Identification of need in relation to a specialty  Dedicated specialist and support of department  Buy in from Primary Care  Time to Develop/Adapt System  Population Management Tool

28 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 28 Identification of Need  Cardiologist—Are PCPs managing CHF on their own and if so, correctly?  Rheumatologist—are PCPs using allopurinol for patients with frequent gout attacks?  Vascular Surgeon—are there unreferred patients with large aortic aneurysms?  Can look at any lab/report, identify the extremes in the population, and determine need

29 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 29 Population Management—Needs  Identification of need in relation to a specialty  Dedicated specialist and support of department  Buy in from Primary Care  Time to Develop/Adapt System  Population Management Tool

30 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 30 Population Management Tool—Major Elements  Regular access to updated data  Stratification and sorting of patients  Patient-centric view  Ability to review case in detail (EMR)  Capacity to annotate  Integration of new data and permanent data  Message generator

31 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 31 Population Management Tool—Major Elements  Color coding of both Data Elements and Individual Patient Cards  “Alert” capability—warning system for acute disease, and worsening chronic disease  “Submerge” capability—hide patient cards for a specified period of time  Capability to generate statistics

32 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 32 Population Management Tool—Major Elements  Real-Time Lab Data  Web based

33 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 33 Renal Population Management System  Nephrology assumes “ownership” of CKD population  Potential high-risk patients identified and examined in detail using KP HealthConnect  E-consults used as KP HealthConnect messages to PCPs  The e-consults are followed up  Low risk referrals are returned to PCPs

34 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 34 Renal Population Management System

35 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 35 Population Management of CKD—Outcomes  Prevents Late Referral  Improves Preparation for Dialysis  Prevents Unnecessary Referral  Improves Screening Rates  Lowers rate of End Stage Renal Disease

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41 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 41 Population Management of CKD— Anecdotal or Pending Outcomes  PCP education  PCP satisfaction with Specialty Support  Cost containment

42 © Copyright Kaiser Permanente, 2008 | For Internal Use OnlyNational Quality & Brand Conference | Page 42 To Sum Up—Why Should a Specialist Attempt to Manage a Population of Disease?  We’re all in this together, PCPs and Specialists  Can make a huge impact on quality and cost  Education of our colleagues can occur in an unusually direct and powerful way  Because now, it can be done

43 Thank you Questions and Discussion

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