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

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

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Page 1: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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Introduction to Kaiser Permanente

Robert M. CraneDirector,

Kaiser Permanente

Institute for Health Policy

Page 2: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, 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

Page 3: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 4: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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TE Our Mission

To provide high quality, affordable

health care services and to improve

the health of our members and the

communities we serve.

Page 5: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 6: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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Kaiser Permanente Partnership

Permanente Medical Group

• Common Vision • Exclusivity• Joint Governance & Decision-Making

Kaiser FoundationHealth Plan

& Hospitals

Page 7: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 8: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 9: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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.

Page 10: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 11: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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TE Health Plan Enrollment by Plan Type, 1988-2001

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

Page 12: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 13: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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Areas of Focus

• Care Management

• Information Technology

Page 14: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 15: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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TE The traditional cost “iceberg”...

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.

Page 16: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 17: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 18: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 19: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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TE 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

Page 20: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 21: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 22: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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TE Our Entire Organization is

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

Page 23: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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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

Page 24: KAISER PERMANENTE 1 Introduction to Kaiser Permanente Robert M. Crane Director, Kaiser Permanente Institute for Health Policy

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Kaiser Permanente

• People

• Understanding

• Health