at Kaiser Permanente, Southern California April 2017

Transcription

1 Complete Care at Kaiser Permanente, Southern California April 2017 Tim Ho, MD, MPH Regional Assistant Medical Director, Quality & Complete Care Southern California Permanente Medical Group Session Objectives Create large-scale improvement through the implementation of systems thinking and approaches Identify key actionable strategies to improve quality 1

2 Who is Kaiser Permanente? What is Complete Care? Regional Outreach SureNet (Safety Net) Proactive Care and Proactive Office Encounter (POE) Online Personal Action Plan (opap) We are Kaiser Permanente Kaiser Foundation Health Plan Kaiser Foundation Hospitals Permanente Medical Groups Source: 2

3 We are Kaiser Permanente Members: 11.3 million Locations: Eight States & The District of Columbia Facilities: 38 hospitals 668 medical offices Personnel: 21,275 physicians 54,072 nurses 201,024 employees Photos: Kaiser Permanente Source: We are Kaiser Permanente, Southern California Members: 4.2 million Facilities: 14 hospitals 222 medical offices Personnel: 7,274 physicians 68,595 employees Photos: Kaiser Permanente Source: 3

4 Julien Dupré ( ) In Pasture 1882, French Source: JAMA 4

5 A little history Photo: Staples 5

6 A little history Photo: Staples Photo: Staples 6

7 4/21/2017 A little history Wenger 1893 Heritage Swiss Army Knife Source: 7

8 4/21/2017 A little history Clinical Practice Guidelines Disease Management Registries Decision Support Wenger 1893 Heritage Swiss Army Knife Source: Wenger Giant Swiss Army Knife Source: 8

9 Complete Care Functions and Systems Complete Care Ecosystem 9

10 Clinical Practice Guidelines Evidence Based or Consensus Based Information Systems 10

11 Regional Outreach Letters and e-letters Automated and Live Calls Text Messaging Colorectal Cancer FIT Kits Proactive Panel Management A standardized and centralized process where the healthcare team supports physicians in managing their panel of patients by extracting and evaluating patients with key, actionable care gaps, and providing patient-specific recommendations to help close key care gaps outside of a face-to-face encounter especially, for those patients not actively seeking care. Improving lives outside the walls of our medical office buildings. 11

12 Proactive Panel Management KPSC Regional Outpatient SureNet Categories of Outpatient Safety Risk Diagnosis Detection and Follow Up Medication Safety 12

13 Regional Safety Net Diagnosis Detection & Follow Up PSA Electronic Safety Net +FIT Electronic Safety Net Abnormal Pap Electronic Safety Net Kidney Disease (Repeat Creatinine) Colon Cancer (Iron Deficiency Anemia + No colonoscopy) Colon Cancer (Rectal Bleeding+ No colonoscopy) Abdominal Aortic Aneurysm Tracking Post Splenectomy Immunizations Positive Chlamydia Follow up Down Syndrome Care Coordination Sickle Cell Care Coordination Hepatitis C (+Antibody + No confirmatory test ) Newborn Hearing Screening Lung Nodules Hepatitis C Primary Hyperparathyroidism Benign Prostatic Hyperplasia Suicide Medication Safety Annual Lab Monitoring: Digoxin (K+, level and SCr), Diuretics (Na+ and SCr) Amiodarone (Preventive monitoring plan) Acetaminophen Overuse Elderly Care Drug-Disease (Falls) Elderly Care Drug-Disease (Dementia) Elderly Care High Dose Digoxin Conversion Diuretic Medication Induced Hyponatremia Medication Induced Hyperkalemia NSAIDs in CKD 4-5, Dialysis, Kidney Transplant Post-TAB Counseling / INH ALT monitoring Birth Control Monitoring Plaquenil Eye Monitoring Metformin Vitamin B12 monitoring Ethambutal eye monitoring Copyright 2015 Kaiser Permanente Slide 25 Diagnosis Detection and Follow Up : Abdominal Aortic Aneurysm Tracking Of deaths caused by ruptured AAAs, 25% were previously diagnosed with AAA without follow-up 78,000 screened for AAA 16,501 under surveillance/intervention 2,605 received intervention 13

14 Proactive Care AAA Screening Rate Trend 14

15 Proactive Care Problem How do you improve the clinical quality outcomes and have a consistent and systematic delivery of care among different medical centers and clinics within a region? 15

16 Goal of Proactive Encounter Improve consistency and quality of the patient care experience care by: Activating all members of the healthcare team in providing a proactive patient care experience Embedding processes to support preventive and chronic care needs into standard workflows Utilizing information technology tools for identification of patient care gaps Three Pillars of POE 16

17 Standard Work Flow Proactive Care Standard Work Flow Proactive Office Encounter Team Agreement For Provider MA/LVN/RN Our Cause is Health. Our Passion is Service. We re Here to Make Lives Better 17

18 Proactive Encounter Approach Results in: Consistent support to physician practice Panel ownership and performance Empowered and engaged staff Better partnership between physician and health care team Improved quality and patient care experience Proactive Checklists 18

19 Survey Physician Survey Making the Business Case for Specialty POE 19

20 Proactive Encounter Patient Story Patricia Vasquez, Kaiser Permanente Member Successful Opportunities Target Met within 30 Days 20

21 Clinical Strategic Goal Improvement Clinical Strategic Goal Pre-POE 2006 POE Piloted 2007 POE implemented Regionally %Improved ( ) Breast Cancer Screening(Ages 52-74) Colorectal Cancer Screening Cervical Cancer Screening (Ages 21-65) Diabetes Lipid Screening (profile) performed Diabetes HbA1c testing Diabetes BP control < 140/90 mm Hg Diabetes Eye exam (retinal) performed Controlling high BP (ages 18-85) Osteoporosis Management in Woman who had Fracture Osteoporosis Testing in Older Women Influenza immunization rate (members 65+) Chlamydia Screening Successful Practices Leadership and Oversight Accountability and Results Reporting Team Sport Utilize everyone Do today s work today Close care gaps when the patient is present Team meetings and huddles Close the loop Coordinate outreach with aspirations of efficiency & effectiveness 21

22 Online Personal Action Plan (opap) Online Personal Action Plan - opap The online Personal Action Plan (opap) is a patient facing platform, designed for patients to proactively manage their own care, learn about their conditions and communicate with their care team. 22

23 What is opap? Empower members to proactively close their own care gaps through technology profile the patient a real time personalized view of their health patients in a way that would allow them to become part of their own care team and proactively close their own care gaps patients become educated about the importance of screenings and treatments to their health for patients to take action in their own health for patients to get care any time and any place Personalized Platform opap s notification engine is capable of sending many personalized s types: Appointments Medication(s) refill My pregnancy New media Questionnaire Upcoming visit Vision Daily reminder 23

24 Pre-Visit Interactive Personalized Education 24

25 Interactive Colon Cancer Screening Over 10,000 kits ordered since 12/19/ % of those kits completed and returned within days. Medication Titration 25

26 opap Data & Publications opap Publications 26

27 opap Effective Gap Closure opap vs Unregistered UsersGap Closure Rates 50.00% 45.00% 40.00% 46.15% 42.24% opap has demonstrated it is an effective tool to help patients self manage 35.00% 30.00% opap users show that they are more effective in closing key care gaps such as cancer screening. (n=684k) 25.00% 20.00% 15.00% 23.07% 19.10% 18.09% 24.58% 18.56% 10.00% 11.84% 12.47% 10.67% 5.00% 6.00% 6.52% 0.00% A1c Gap Closure Rate Flu Gap Closure Rate Pneumococcal Gap Closure Breast Cancer Screening Gap Rate Closure Rate opap Users Unregistered Users Cervical Cancer Gap Closure Rate Colorectal Cancer Gap Closure Rate HEDIS Improvement - Baseline 2009 vs

28 Clinical Strategic Goals Benefits Achieved 2004 Nov Metric Increase Savings Per Decade Cholesterol control 34.9% 2,738 Lives Blood pressure control 44.1% 6,054 Lives HbA1C < % 1,379 Lives Smoking cessation 17.0% 1,011 Lives Breast cancer screening 10.3% 515 Lives Cervical cancer screening 11.6% 116 Lives Colon cancer screening 38.9% 6,166 Lives Total: 17,979 Lives 5 5 Relative Five Year Survival Rates 56 28

29 Publications Joint Commission Journal on Quality & Patient Safety, November 2013; 39(11): Avedis Donabedian Primary Architect of Health Care Quality 29

30 Structure Process Outcome Systems awareness and systems design are important for health professionals, but they are not enough. They are enabling mechanisms only. It is the ethical dimensions of individuals that are essential to a system s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system. 30