An Introduc+on to Cancer Care at Kaiser Permanente Northwest. Phoebe E. Harvey, MD Chief, Hematology/Oncology Medical Director, Cancer Service Line

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1 An Introduc+on to Cancer Care at Kaiser Permanente Northwest Phoebe E. Harvey, MD Chief, Hematology/Oncology Medical Director, Cancer Service Line April 16, 2016

2 Agenda Overview and history of KP Northwest Overview of Cancer Service Line Overview of Hematology/Oncology Medical Culture at KPNW Preven+on Evidence- based medicine Standardiza+on

3 History of KP Northwest Industrialist Henry J. Kaiser pioneered the development of prepaid group prac+ce with his shipyard workers in Portland & Vancouver Goal: Keep workers healthy and produc+ve through preven+on and +mely medical care When the shipyards closed auer WWII, enrollment was opened to the community region was officially established in 1951 Above: First Lady Eleanor Roosevelt visits an injured shipyard worker at the Permanente Hospital in Vancouver, WA (1942)

4 KPNW Facts & Figures KPNW is a partnership between Northwest Permanente physicians group, Kaiser Hospitals and Kaiser Health Plan 543,000 members Approx. 1,000 physicians and 11,000 employees Two KP hospitals (Sunnyside and Westside), and arrangements with several other community hospitals 32 outpa+ent medical offices Only Kaiser region with an integrated dental program

5 KPNW Cancer Service Line Cancer delivery in the secng of coordinated and streamlined care Oversight by medical director and administra+ve partner Cancer Service Line Oversight Council Cancer Task Forces

6 Cancer Oversight Current State Breast Task Force Head & Neck Thoracic GI Medical Director and Administra1ve Director Cancer Service Line Oversight Council Genitourinary Chiefs of Med Onc, Rad Onc, Surg Onc, and representa+ve from, Quality/Popula+on Care, Ambulatory Nursing, Analy+cs, Research, Tumor Registry, Pallia+ve Care GYN Skin Orthopedics Lower GI Leukemia & Lymphoma Central Nervous System

7 Task Forces 10 task forces (organized by cancer type) each is chaired by a physician in the appropriate department Goals of task forces: Engage pa+ents in Co- Design Iden+fy areas for improvement in care delivery Take improvement projects back to respec+ve departments to develop new work flows. Monitor quality metrics relevant to specific area (diagnosis and treatment) Choose community events related to area and organize par+cipa+on ie Breast Task Force: Race for the Cure. Help guide research trial opportuni+es and promote clinical trial enrollment Communicate back to Medical Group and Staff about Progress Seek input from the relevant specialty about improvements for the Cancer Program

8 Pa+ent Mapping Sessions Each Task Force completed a mapping session to capture current state based on pa+ent experiences/feedback Scope: From screening to survivorship Goal: Listen to pa+ent voices to help us understand the good and the bad about our care delivery What worked well, what didn t, what would they have appreciated or liked to see more of during their cancer journey

9 Using the Pa+ent Voice Phase 1: Map Current State Map current workflow from each specialty Capture process steps from screening through treatment Phase 2: Map Future State Invite pa+ents to tell their story Iden+fy desired future state experience Brainstorm new ideas together Priori+ze Phase 3: Improvement Design improvement and measurement strategy Execute Phase 4: Sustain Create and Execute sustainability plans

10 Pa+ent Advisory Council Oncology Pa+ent Advisory Council created in early 2014 Opportunity for physicians and administrators to solicit ongoing feedback about new or proposed changes to the cancer program Meets bimonthly agenda is pa+ent- driven Council benefits from pa+ent diversity - variety of ages, cancer types, backgrounds

11 KPNW Hematology/Oncology Regional Department 13 MDs, 2 NPs Specializa+on Longview Kelso to Salem Inpa+ent service and 3 outpa+ent clinics Oncology pharmacy, cancer counseling, specialized RN support, pallia+ve care

12 KPNW Hematology/Oncology Not an RVU- based prac+ce Not fee for service Protected +me for seeing pa+ents and new consults No prior authoriza+ons No restric+ons on choice of drug

13 Medical Culture at KPNW Preven+on Evidence- based medicine Standardiza+on to improve quality

14 Preven+on and Screening Cancer preven+on & screening is woven throughout the care delivery system Inreach (in- clinic) and outreach happens consistently to ensure pa+ents stay up to date with important screenings (CRC, Pap, mammogram) A Pa+ent Support Tool is embedded into the EMR and shows real- +me informa+on on care gaps the pa+ent needs to close Inreach: Everyone has a role in reinforcing the PST care gap reminders at every visit! MAs, RNs, MDs, pharmacists, Imaging staff, techs, etc.

15 Preven+on and Screening (cont) Outreach: Pa+ents receive +mely, coordinated reminders (leqers, phone calls, kp.org reminders) encouraging them to complete the tests/ screenings for which they are Example: All members due for CRC screening receive a Fecal Immunochemical Test (FIT kit) in the mail during their birthday month Preven+on: Exercise as a Vital Sign is part of the rooming process for every pa+ent at least once every 6 months Extensive resources (Health Coaches, online programs, in- person classes) to help pa+ents with tobacco cessa+on, weight management, nutri+on, stress, and other primary preven+on areas

16 Preven+on and Screening (cont) Results: KPNW is consistently above the 90th percen+le (HEDIS/ NCQA) for colorectal, breast cancer and cervical cancer screening CRC screening rate is consistently at or above 80% of eligible members significantly higher than state and na+onal average Targeted ini+a+ves/tac+cs focus on reducing healthcare dispari+es in 2015 KPNW reduced the colorectal cancer screening disparity between white and Hispanics to <1% Safety net system is in place to follow up on abnormal imaging results ( Yellow Dot ) and ensure pa+ents receive appropriate follow- up scans to monitor

17 Community Ini+a+ves KPNW Community Benefit performs annual needs assessments and awards grants to groups working on measurably improving community health Poder y Vida 5- year project aimed at reducing late- stage breast cancer diagnoses among La+nas in NW Oregon KPNW is contribu+ng $1.3 million, including 2,800 free mammograms, to support the ini+a+ve The donated screenings follow a Pathways model of care, an evidence- based interven+on method that addresses barriers at each step of the process, using culturally competent, bilingual community health workers as pa+ent advocates. Sponsors and par+cipates in community events and programs Sunday Parkways, American Heart Associa+on Heart & Stroke Walk, Race for the Cure

18 Evidence- Based Medicine Na+onal Beacon Program Protocol review Early iden+fiers of trends Growth factor support with TC Growth factor support with TCHP Bisphosphonate reviews

19 Research Overseen by medical oncology Works in conjunc+on with the Center for Health Research Currently 30 open studies encompassing wide range of disease types Coopera+ve trials along with pharma trials Highest recruiter for SWOG

20 Standardiza+on of Care Goals: Reduce redundancy and varia+on, reduce costs, improve outcomes, ensure high- quality pa+ent experience every +me Examples: Defined flow pathways auer cura+ve therapy for breast cancer Post- CRC surveillance protocol Sleepless Nights ini+a+ve Reduce +me from abnormal mammogram to biopsy

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