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

Panel Management — Update and Future Directions

Robert Unitan, MD, Kaiser Permanente NorthwestBrian J. Lee, MD, Kaiser Permanente Hawaii

© Copyright Kaiser Permanente, 2008 | For Internal Use Only National Quality & Brand Conference | Page 2

The 1:1 visit alone leaves primary care unsustainable

– Donald Berwick, MD

We Need to Do Things Differently….


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.


Enterprise Data Warehouse (EDW)

Claims

Membership

Ancillary

PCMCapabilities

Leverage data from KP HealthConnect to provide the backbone for panel management capabilities

Panel Management and KP HealthConnect


Panel Ownership and Complete Care


Specific Treatment Recommendations


All PST Data is Refreshed Nightly


Birthday Outreach for All Members


Sort by Contact Modality or Utilization


Monthly Performance Feedback


KPNW DM Screening—2007

HEDIS Effectiveness of Care Measure

Q4 2006 2006 HEDIS 90th Percentile

Q4 2007

DM HBA1c

Screening90.8% 92.7% 93.5%

DM LDL

Screening85.4% 85.4% 90.9%

DM Retinopathy

Screening69.6% 69.3% 75.3%

DM Nephropathy

Screening89.4% 91.2% 92.6%


A.L.L. for DM and CVD (n=45K)

Q4 2006 Target Q4 2007

ASA + Statin + Lisinopril

47.3% 50.8% 55.7%



Single Sign-On

2

Panel Support Tool Integration

Able to

print


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

Panel Management— Update and Future Directions

PART 2Brian J. Lee, MD

Kaiser Permanente Hawaii


Primary Care —Panel Management

Specialty Care — Panel Management

Primary Care — Population Management

Specialty Care — Population Management

Types of High-Level Care


Twelve PCPs, Twelve Panels


Twelve PCPs, Twelve Panels . . . Add a Disease

Red=referred Orange=unreferred


Twelve PCPs, Twelve Panels. . . and a Specialist


Population Management—CKD at KPHI

Seeing Nephrologist—1,000

Kidney disease—15,000

Member population—210,000


Panel Management vs. Population Management


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.


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


Panel Management vs. Population Management


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


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


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


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


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



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



Real-Time Lab Data Web based


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


Renal Population Management System


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

Late Referral (<4 Months Prior to ESRD)

0%

5%

10%

15%

20%

25%

30%

35%

40%

KPHI 2004 KPHI 2005 KPHI 2006 KPHI 2007

Pe

rce

nt

La

te KPHI 2004

KPHI 2005

KPHI 2006

KPHI 2007

Fistula Present, Start of Hemodialysis

0%

10%

20%

30%

40%

50%

60%

2004 2005 2006 2007

Year

Pe

rce

nt

Fis tulas Present


Population Management of CKD—Anecdotal or Pending Outcomes

PCP education PCP satisfaction with Specialty Support Cost containment


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

Thank you

Questions and Discussion

Documents

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