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Introduction to Kaiser Permanente
Robert M. CraneDirector,
Kaiser Permanente
Institute for Health Policy
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• Overview
• Mission
• Structure & Key Features
• History
• Comparison To NHS & US Plans
• Areas Of Focus– Care Management– Information Technology
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TE 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
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To provide high quality, affordable
health care services and to improve
the health of our members and the
communities we serve.
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A Prepaid Integrated Delivery System With Aligned Incentives
Kaiser Foundation Hospitals
PermanenteMedicalGroup
KaiserFoundationHealth Plan
Health PlanMembers
• Social Purpose
• Quality Driven
• Shared Accountability for Program Success
• Integration along Multiple Dimensions
• Prevention & Care Management Focus
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Kaiser Permanente Partnership
Permanente Medical Group
• Common Vision • Exclusivity• Joint Governance & Decision-Making
Kaiser FoundationHealth Plan
& Hospitals
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TE 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
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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
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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.
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Private Insurance34%
Other Public1
12% Other Private2
6%Medicaid and
SCHIP15%
Out-of-pocket15%
Medicare17%
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.
CMSPrograms
33%
Medicare, Medicaid, and SCHIP account for one-third of national health spending.
Total National Health Spending = $1.3 Trillion
America’s Health Dollar, CY 2000
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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.
Over the 1990s, managed care grew dramatically.
73%
46%
27%
14%
9%
8%
7% 23%
29%
28%
27%
31%
21%
16%
35%
38%
41%
48%
28%
26%
11%
24%
25%
22%
22%
14%
7%
0% 20% 40% 60% 80% 100%
1988
1993
1996
1998
1999
2000
2001
Conventional
HMO
PPO
POS
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TE Northern California Member Demographics
Total Membership: 3.2 Million
28%: 0-19
35%:%: 20-44
12%:65+
25%: 45-64
AgeAge
11%:Medicare
2%:Medi-Cal
87%: Commercial
CoverageCoverage
4%: Other
12%: Asian
7%: African American
11%: Latino11%: Latino
66%: Caucasian
EthnicityEthnicity
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Areas of Focus
• Care Management
• Information Technology
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Distribution of Annual Health Care Spending Across Entire US Population 2000
Source: Lewis 2000
$14 $224 $695$1,992
$4,919
$22,578
$0
$5,000
$10,000
$15,000
$20,000
$25,000
1-20%. 21-40% 41-60% 61-80% 81-90% 91-100%
Percent of Population
Co
st o
f H
ealt
hca
re
Costs are not evenly distributed
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Distribution of total commercial population
Costs associated with each segment
Employees $$$
10%
40%
50% 5%
29%
65%
Source: 2001 Northern California, Group XYZ Commercial Membership; DxCG methodology.
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Segments within the total population
Costs associated with each segment
Those w/no chronic conditions
Those w/one chronic condition
Those w/multiple chronic conditions
People $$$
72%
21%
6%
36%
31%
33%
Source: Kaiser Permanente Northern California commercial membership, DxCG methodology, 2001.
Chronic Illness Drives Medical Care Costs
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TE 10 Clinical Priority Areas
KP Members Clinical Area with this Condition
Asthma 141,000
Coronary Artery Disease 256,000
Depression 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
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TE Population Management:
More than Care & Case Management
Intensive
or Case Management
Assisted Care or Care Management
Usual Care with Support
Level 170-80% of a
CCM pop
Level 2High risk members
Level 3Highly complex members
Targeting Population(s)
Redesigning Processes
Measurement of Outcomes & Feedback
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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
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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
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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
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Impacted
Lab
Radiology/Imaging
Others (immunizations, EKG, dictation)
Outpatient Pharmacy
Care Delivery Core Health Plan
ClaimsProcessing
Membership/Benefits
Benefits Accumulation
PricingSystem
Outpatient
Clinicals
Scheduling
Registration
Inpatient
Scheduling
Billing
Pharmacy
Registration
EmergencyDepartment
Clinicals
Web Access Portal
Data Warehouse / EDR Enterprise Data Repository
Scope of KP HealthConnect Suite
Billing
Ancillaries
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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
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Kaiser Permanente
• People
• Understanding
• Health
