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5/9/2012




Kaiser Permanente's Healthcare IT Journey
                         George C. Halvorson
                         Chairman and Chief Executive Officer
                         Kaiser Permanente




          Kaiser Permanente

     Kaiser Permanente is both a
   health care delivery system and a
      health insurance/financing
              mechanism.


                                                                2




                                                                          1
5/9/2012




   We provide all elements of care:
              Hospitals

                Clinics

                 Labs

             Pharmacies

            Image Centers

                 Etc.

                                      3




     Kaiser Permanente

  We are the largest private
medical groups in the world and
  we are one of the largest
 hospital systems in the U.S.


                                      4




                                                2
5/9/2012




    Kaiser Permanente


   We serve nine million
    member/patients.



                                5




    Kaiser Permanente

We employ 180,000 workers --
 almost all in care delivery.




                                6




                                          3
5/9/2012




        Kaiser Permanente

   We have annual revenues of
       $50 billion dollars.




                                              7




          Kaiser Permanente

      We are “prepaid” for our care.


     We sell a total package of care.

We are not paid based on separate fees that
 are charged for separate pieces of care.

                                              8




                                                        4
5/9/2012




     Kaiser Permanente Flexibility

We can use the $50 billion we receive in
 revenue to provide the care that our
    patients need… rather than just
delivering the pieces of care to patients
  that build a FFS piecework revenue
             stream for us.


                                            9




         Kaiser Permanente

  We are accountable for the total
  care -- and for the total health --
   of our nine million members.



                                        10




                                                      5
5/9/2012




     Kaiser Permanente
    We need to make smart
    decisions about how we
deliver care and how we create
             health.



                                 11




     Kaiser Permanente

       We know that --

   Care costs are not evenly
         distributed.


                                 12




                                            6
5/9/2012




13




14




           7
5/9/2012




                                                     15




            What does that tell us?




It tells us to focus and it tells us to intervene.
                                                     16




                                                                8
5/9/2012




Who are the patients that are
 creating the major costs of
            care?




                                17




  Are the high cost patients
 cancer, contagious disease,
broken bones and lacerations,
   and acute care patients?


                                18




                                           9
5/9/2012




  Do we spend most health care
dollars on cancers, cuts, contusions,
      concussions, and colds?




                                    19




               NO.


                                    20




                                              10
5/9/2012




 Cancer, contagious diseases,
broken bones and lacerations,
   and acute care patients?

 Most care costs come from
    chronic conditions.

                                21




 Chronic diseases create 75%
     of the costs of care



       Chronic Care
        75%   Acute Care
                 25%


                                22




                                          11
5/9/2012




   Patients with multiple health conditions --
co-morbidities -- create 80% of the costs of care.



               Co-morbidities
                80%
                          20%

                                                23




        How is that information
             useful to us?




                                                24




                                                          12
5/9/2012




  1) It tells us where to focus.




                                    25




2) It tells us how to make a real
  difference in care and costs.



                                    26




                                              13
5/9/2012




 Patients with co-morbidities
and chronic conditions need --


        TEAM CARE

                                 27




 We need the right care and
 we need consistent care…
  with teams of caregivers
  focused on the needs of
    individual patients.


                                 28




                                           14
5/9/2012




       Chronic Care Patients
Question:

Do you want your health care provider to
work as a team to coordinate your care?


            Answer: YES (97%)


                                           29




       Chronic Care Patients
Question:

Do your health care providers work as a
team to coordinate your care?


            Answer: No (46%)

                                           30




                                                     15
5/9/2012




     How can we create team
    care, connected care, right
       care, and best care?



                                  31




Think Tools --

 We need care support tools to
 help make that work possible.


                                  32




                                            16
5/9/2012




  What tools do we need?
 1. Data


 2. Connectivity

 3. Continuous improvement skills and
    processes

 4. Care support protocols and tools

                                        33




     The Prime Directive:

Make the right thing easy to do!




                                        34




                                                  17
5/9/2012




To make the right thing easy to do,
           we need to:

1. Figure out the right thing.

2. Make it easy to do.

      (Make the right thing easy to do
    is the CMI mantra and the systems
   commitment at Kaiser Permanente)

                                         35




  Paper medical records are a
huge impediment to care quality
    and care improvement.



                                         36




                                                   18
5/9/2012




     Paper is isolated, inaccessible,
    not interactive, incomplete, and
            often inaccurate.
      Paper is -- at its best -- inert.



                                            37




Paper is isolated, inaccessible, not
interactive, incomplete, and often
inaccurate -- it is at its best -- inert.


Paper records do not and cannot make
the right thing easy to do.


                                            38




                                                      19
5/9/2012




To deliver best care for each
 patient, we need real-time
information about all of our
patients at the point of care.



                                 39




All          All         All


      (Mantra number two)
                                 40




                                           20
5/9/2012




    We very much need the
caregivers who share patients to
share data about their patients.



                                     41




     We also need real-time
   information about medical
    science and best practices
available to our caregivers at the
          point of care.


                                     42




                                               21
5/9/2012




   There are 60,000 medical
 journals published every year.
    Medical science changes
continuously. No caregiver can
     keep up on their own.



                                  43




        So what did
Kaiser Permanente do to go
    down those paths?



                                  44




                                            22
5/9/2012




 We invested four billion dollars
in building an electronic medical
record and a set of care support
 tools for our care sites and care
              teams.


                                     45




   We have real-time and
complete electronic patient
information for our doctors
    at the point of care.



                                     46




                                               23
5/9/2012




We have real-time information
  about most current medical
   science and best practices
 available for our doctors and
care teams at the point of care.



                                   47




                                   48




                                             24
5/9/2012




                                 49




  We also now have the data
needed to track care and to do
real-time medical research and
     process improvement.



                                 50




                                           25
5/9/2012




We have completely linked our
  care delivery facilities -- with
paperless lab reports, electronic
   transmissions of tests, and
electronic care reporting for our
   hospital and medical care.


                                     51




We probably have the lowest
     insurance related
 administrative costs of any
  health plan in America.


                                     52




                                               26
5/9/2012




       We have the best
patient/doctor connectivity
  -- through our electronic
connections to our patients.


                               53




  We win just about every
 quality award in America.




                               54




                                         27
5/9/2012




   Top HEDIS scores in
      21 categories.



                                55




 Medicare rated 459 health
plans -- using 53 quality and
     service measures.



                                56




                                          28
5/9/2012




Health plans were rated from
      one to five stars.




                               57




 Only nine health plans in
 America earned five stars.




                               58




                                         29
5/9/2012




Five Kaiser Permanente Regions
won the full five stars --

  and our lowest score for any
     KP Plan was 4.5 stars.



                                 59




 We won the “Star Wars”
     for Medicare.



                                 60




                                           30
5/9/2012




We were also rated number
  one as a health plan by
 J.D. Power & Associates.



                            61




  You can look up our
   consumer ratings.



                            62




                                      31
5/9/2012




The tool kit works.



                                63




   Team Care Works

 Reduced broken bones by 43%

  Reduced HIV deaths to half
     the national average

 Reduced heart disease deaths
           by 30%

                                64




                                          32
5/9/2012




   We also have set up
  important programs to
    support safe care.



                                65




Sepsis kills more patients in
 American hospitals than
  cancer, heart disease or
            stroke.



                                66




                                          33
5/9/2012




               We put data supported team care
               in place for our sepsis patients --
                and we cut the death rate from
                   sepsis by more than half.



                                                                                                                                                                                                                                                                                 67




                        Sepsis Hospital Mortality Rates
0.25




 0.2




0.15




 0.1




0.05




  0
                                       39934




                                                                                                                                                                                                                                                               40756
       39814
               39845
                       39873
                               39904


                                               39965
                                                       39995
                                                               40026
                                                                       40057
                                                                               40087
                                                                                       40118
                                                                                               40148
                                                                                                       40179
                                                                                                               40210
                                                                                                                       40238
                                                                                                                               40269
                                                                                                                                       40299
                                                                                                                                               40330
                                                                                                                                                       40360
                                                                                                                                                               40391
                                                                                                                                                                       40422
                                                                                                                                                                               40452
                                                                                                                                                                                       40483
                                                                                                                                                                                               40513
                                                                                                                                                                                                       40544
                                                                                                                                                                                                               40575
                                                                                                                                                                                                                       40603
                                                                                                                                                                                                                               40634
                                                                                                                                                                                                                                       40664
                                                                                                                                                                                                                                               40695
                                                                                                                                                                                                                                                       40725


                                                                                                                                                                                                                                                                       40787
                                                                                                                                                                                                                                                                               40817




                                 Source: Joint Commission Journal on Quality and Patient Safety, November 2011
                                                                                                                                                                                                                                                                                 68




                                                                                                                                                                                                                                                                                            34
5/9/2012




If the rest of America had that same
 Kaiser Permanente sepsis response
 program in place, that would have
  saved 72,000 lives in America last
   year -- and reduced eight million
    very expensive hospital days.



                                       69




    Likewise -- with hospital
   acquired pressure ulcers --
focused science based team care
  can make a huge difference.



                                       70




                                                 35
5/9/2012




 Roughly 2.5% of patients in
   American hospitals get
 pressure ulcers -- and many
  patients are damaged and
    killed by those ulcers.



                                  71




Team care at Kaiser Permanente
 has reduced pressure ulcers by
          two thirds.




                                  72




                                            36
5/9/2012




Hospital-Acquired Ulcers (HAPU) Stage 2 Plus

                                             All KP Hospitals                 CalNOC Average

4.0%

           CalNOC (2008) Average
3.5%


3.0%
                       KP Average
2.5%


2.0%


1.5%


1.0%


0.5%


0.0%
         Q208   Q308   Q408   Q109    Q209   Q309     Q409      Q110   Q210    Q310   Q410     Q111   Q211   Q311   Q411


       CalNOC consists of a coalition of California hospitals who are working together on patient safety issues.

                                                                                                                           73




        Having extensive and available
        data about care facilitates both
          care improvement and care
         quality improvement agendas




                                                                                                                           74




                                                                                                                                     37
5/9/2012




     Our Board of Directors
  focuses on quality as a major
     part of our governance
             process.


                                       75




   Our Kaiser Permanente Board of
 Directors Quality Committee meets
more often and longer than our Board
 Finance Committee or our Executive
             Committee.



                                       76




                                                 38
5/9/2012




We provide the KP Board and senior
 leadership with a monthly update
   on more than 200 measures of
        safety and quality.

           The Big Q


                                     77




 The Big Q report is available to
 any Board member at any time
    by electronic reporting.



                                     78




                                               39
5/9/2012




                       -- We Steer Toward Quality --




•Health Plan Quality                  •Quality Management
•Healthcare Analytics                 •Resource Stewardship
•Patient Safety                       •Risk Management
•Performance Improvement              •Service Quality
•Population Health


                                                              79




                                                              80




                                                                        40
5/9/2012




                              HEDIS National 90th Percentile




                                                               81




                      Archimedes

• KP also invests in leading edge technology such as
  Archimedes.
• Archimedes is a person specific computer simulation
  model used to understand the likely health outcomes
  and costs of decisions from the policy level to individual
  patient decisions.
• Archimedes is now assisting the European Health Checks
  project.
• Targeted health checks for individuals at the highest risk
  are cost-effective.

                                                               82




                                                                         41
5/9/2012




We focus on quality and we use
  our systems to support our
 quality improvement efforts.



                                 83




We also focus on connectivity.




                                 84




                                           42
5/9/2012




  Our website -- KP.org -- was used a
    hundred million times by our
   members and patients last year.




                                        85




  We started connecting with our
members on the internet in large scale
      efforts five years ago.

Our member website -- KP.org -- was
 used more than a hundred million
         times last year.

                                        86




                                                  43
5/9/2012




  Our patients can use the internet to:

        See their medical record

          Make appointments

          E-mail their doctors

        Order prescription refills

    Learn about their health or care

                                          87




  We sent out 60 million lab
results electronically last year.




                                          88




                                                    44
5/9/2012




  We believe that up to 40% of
face-to-face patient visits might
     be done electronically.




                                    89




    We now do 40% of our
 dermatology visits with video
   links and e-connectivity.




                                    90




                                              45
5/9/2012




 Our new Android and iPhone
app had nearly two million uses
      in the first month.




                                  91




      New Mobile Apps




                                  92




                                            46
5/9/2012




Patients love being connected.




                                 93




So where do we go from here?




                                 94




                                           47
5/9/2012




       The Four Sites of Care


We believe that care in the future will be
delivered in four distinct “sites of care.”



                                          95




       Site One -- Staffed Beds

                Hospitals

             Nursing homes

       Places where people sleep
          and care is delivered.
                                          96




                                                    48
5/9/2012




Site one will be incredibly and
 increasingly well supported
    with great technology.



                                           97




   Site Two -- Face-to-Face
             Clinics, Offices

  Direct ambulatory caregiver encounters

              Exam rooms

         Wide array of care sites
   (Offices, work places/ vans / etc.)

                                           98




                                                     49
5/9/2012




Site two will also be incredibly
      and increasingly well
     supported with great
           technology.



                                    99




   Site two technology will be
     diagnostic, therapeutic,
communicative and remediative
-- with full EMR connectivity and
  care linked to patient specific
             care plans.


                                    100




                                               50
5/9/2012




   Site Three -- In-Home Care

  The home will be a primary
         site of care.

   Care tools will be on-site in
     many people’s homes.


                                   101




Site three will be incredibly
    and increasingly well
   supported with great
         technology.



                                   102




                                              51
5/9/2012




 Some site three technology for in-
home care two years from now will
  be as good or better than actual
 hospital inpatient technology was
           five years ago.



                                      103




    In-home monitoring, EKGs,
 ultrasounds, video conferences,
  blood and fluid diagnostic and
     testing tools and patient
   communication tools will be
    increasingly sophisticated,
       effective, and cheap.


                                      104




                                                 52
5/9/2012




For most people, the home will
 be the primary site of care --
  very well equipped to be a
      great site of care.



                                    105




In-home care will function best
  in the context of a care team
 who knows the patient’s total
   situation and full set of care
              needs.



                                    106




                                               53
5/9/2012




        Site Four -- The Web

   The internet will deliver a lot of care

    Connected, web-located care will
            expand rapidly

        Web care will be available
       everywhere, all of the time.

                                             107




Site four will also be incredibly
and increasingly well equipped
with great technology and tools.




                                             108




                                                        54
5/9/2012




       Portable EKGs

        Care tracking

       Electronic consults

Perpetual monitoring -- linked to
         interventions.

                                    109




     Full data flow for
       each patient


Interactive diagnostic work
    and care planning.


                                    110




                                               55
5/9/2012




Entirely current, complete
patient specific care data --
    at a very low cost.



                                111




The world is now flat for a
      lot of care.



                                112




                                           56
5/9/2012




      Next steps?
Continuous learning will be the
     future of health care.


                                  113




             DNA

      and Causality Research




                                  114




                                             57
5/9/2012




     Research Question:

 When mothers have a uterine
 infection during pregnancy --
does that create higher asthma
       risk for their kids?


                                  115




           Answer:
             YES
The asthma risk is a lot higher
        for the kids.



                                  116




                                             58
5/9/2012




 How much higher?

African American kids
     98%                      increase


  Source: Archives of Pediatric and Adolescent Medicine




                                                           117




 How much higher?

        Hispanic kids
     70%                      increase


   Source: Archives of Pediatric and Adolescent Medicine




                                                           118




                                                                      59
5/9/2012




 How much higher?

  Caucasian kids
  66%                      increase


  Source: Archives of Pediatric and Adolescent Medicine




                                                          119




 How much higher?

Asian American kids
                  ???

  Source: Archives of Pediatric and Adolescent Medicine




                                                          120




                                                                     60
5/9/2012




     How much higher?

   Asian American kids
      Zero % increase

     Source: Archives of Pediatric and Adolescent Medicine




                                                             121




There was no additional risk
  for Asian American kids.



                                                             122




                                                                        61
5/9/2012




 African Americans                      98%                increase

 Hispanics                               70%               increase

 Caucasians                              66%               increase

 Asian/Pacific Islanders                    0%             increase
        Source: Archives of Pediatric and Adolescent Medicine



                                                                      123




KP is currently collecting DNA data.


200,000 samples -- stored in Berkeley.




                                                                      124




                                                                                 62
5/9/2012




        Chronic Care Patients
All Patients:

My health care data should be used to help
improve the care of future patients who might
have the same or similar conditions.


  Agree: 89%         Strongly Disagree: 3%

                                                125




   One use of that data will be to
    figure out what might be a
       genetic factor for the
          asthmatic kids.



                                                126




                                                           63
5/9/2012




     Electronic data lets us
      discover unexpected
  linkages and unsuspected
           causalities.


                                                        127




        Alzheimer’s Research
    High           260% higher        (longitudinal
 cholesterol     Alzheimer’s rate   data -- long time
   in 30s             in 70s            members)



Hypoglycemic     80% higher rate     (two attacks --
                  of Alzheimer’s      160% higher
attack pre-60s        in 70s             rate)


                                    172% increased
Heavy smokers    157% increased
                                    risk of vascular
                      risk of
  in mid life                        dementia two
                   Alzheimer’s
                                     decades later


  (EMR Applied to Longitudinal Research)
                                                        128




                                                                   64
5/9/2012




        Autism Studies

  30%      Higher for older mothers


   50%     Higher for older fathers



                                      129




The risk of autism for children was
   three times higher when the
 mothers to be took a particular
   drug in the first trimester of
pregnancy and twice as high if the
mother took that same drug in the
         second trimester.


                                      130




                                                 65
5/9/2012




   Which trimester is the
       higher risk?



                                  131




   No one suspected any link
between that drug and Autism --
  until the Kaiser Permanente
         study was done.



                                  132




                                             66
5/9/2012




Kaiser Permanente patient data
resulted in Vioxx being removed
     from the marketplace.




                                  133




  We need electronic data.




                                  134




                                             67
5/9/2012




We need electronic data to
     improve care.




                             135




We need electronic data to
    improve science.




                             136




                                        68
5/9/2012




We need electronic data to
       save lives.




                             137




We need electronic data to
     link caregivers.




                             138




                                        69
5/9/2012




So Kaiser Permanente is building a
  tool kit and learning to use the
 new tool kit to make care better,
  safer, more accessible, smarter,
         and less expensive.



                                 139




 We spent four billion dollars
at KP on computer based care
        support tools.



                                 140




                                            70
5/9/2012




Our annual cost and expense level
 is more than five billion dollars a
year below where it would be if we
     did not have those tools.




                                   141




    It’s a good time to use
  computers to support care.




                                   142




                                              71
5/9/2012




Be well


          143




                     72

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Plenary Session Kaiser Permanente Healthcare It Journey

  • 1. 5/9/2012 Kaiser Permanente's Healthcare IT Journey George C. Halvorson Chairman and Chief Executive Officer Kaiser Permanente Kaiser Permanente Kaiser Permanente is both a health care delivery system and a health insurance/financing mechanism. 2 1
  • 2. 5/9/2012 We provide all elements of care: Hospitals Clinics Labs Pharmacies Image Centers Etc. 3 Kaiser Permanente We are the largest private medical groups in the world and we are one of the largest hospital systems in the U.S. 4 2
  • 3. 5/9/2012 Kaiser Permanente We serve nine million member/patients. 5 Kaiser Permanente We employ 180,000 workers -- almost all in care delivery. 6 3
  • 4. 5/9/2012 Kaiser Permanente We have annual revenues of $50 billion dollars. 7 Kaiser Permanente We are “prepaid” for our care. We sell a total package of care. We are not paid based on separate fees that are charged for separate pieces of care. 8 4
  • 5. 5/9/2012 Kaiser Permanente Flexibility We can use the $50 billion we receive in revenue to provide the care that our patients need… rather than just delivering the pieces of care to patients that build a FFS piecework revenue stream for us. 9 Kaiser Permanente We are accountable for the total care -- and for the total health -- of our nine million members. 10 5
  • 6. 5/9/2012 Kaiser Permanente We need to make smart decisions about how we deliver care and how we create health. 11 Kaiser Permanente We know that -- Care costs are not evenly distributed. 12 6
  • 8. 5/9/2012 15 What does that tell us? It tells us to focus and it tells us to intervene. 16 8
  • 9. 5/9/2012 Who are the patients that are creating the major costs of care? 17 Are the high cost patients cancer, contagious disease, broken bones and lacerations, and acute care patients? 18 9
  • 10. 5/9/2012 Do we spend most health care dollars on cancers, cuts, contusions, concussions, and colds? 19 NO. 20 10
  • 11. 5/9/2012 Cancer, contagious diseases, broken bones and lacerations, and acute care patients? Most care costs come from chronic conditions. 21 Chronic diseases create 75% of the costs of care Chronic Care 75% Acute Care 25% 22 11
  • 12. 5/9/2012 Patients with multiple health conditions -- co-morbidities -- create 80% of the costs of care. Co-morbidities 80% 20% 23 How is that information useful to us? 24 12
  • 13. 5/9/2012 1) It tells us where to focus. 25 2) It tells us how to make a real difference in care and costs. 26 13
  • 14. 5/9/2012 Patients with co-morbidities and chronic conditions need -- TEAM CARE 27 We need the right care and we need consistent care… with teams of caregivers focused on the needs of individual patients. 28 14
  • 15. 5/9/2012 Chronic Care Patients Question: Do you want your health care provider to work as a team to coordinate your care? Answer: YES (97%) 29 Chronic Care Patients Question: Do your health care providers work as a team to coordinate your care? Answer: No (46%) 30 15
  • 16. 5/9/2012 How can we create team care, connected care, right care, and best care? 31 Think Tools -- We need care support tools to help make that work possible. 32 16
  • 17. 5/9/2012 What tools do we need? 1. Data 2. Connectivity 3. Continuous improvement skills and processes 4. Care support protocols and tools 33 The Prime Directive: Make the right thing easy to do! 34 17
  • 18. 5/9/2012 To make the right thing easy to do, we need to: 1. Figure out the right thing. 2. Make it easy to do. (Make the right thing easy to do is the CMI mantra and the systems commitment at Kaiser Permanente) 35 Paper medical records are a huge impediment to care quality and care improvement. 36 18
  • 19. 5/9/2012 Paper is isolated, inaccessible, not interactive, incomplete, and often inaccurate. Paper is -- at its best -- inert. 37 Paper is isolated, inaccessible, not interactive, incomplete, and often inaccurate -- it is at its best -- inert. Paper records do not and cannot make the right thing easy to do. 38 19
  • 20. 5/9/2012 To deliver best care for each patient, we need real-time information about all of our patients at the point of care. 39 All All All (Mantra number two) 40 20
  • 21. 5/9/2012 We very much need the caregivers who share patients to share data about their patients. 41 We also need real-time information about medical science and best practices available to our caregivers at the point of care. 42 21
  • 22. 5/9/2012 There are 60,000 medical journals published every year. Medical science changes continuously. No caregiver can keep up on their own. 43 So what did Kaiser Permanente do to go down those paths? 44 22
  • 23. 5/9/2012 We invested four billion dollars in building an electronic medical record and a set of care support tools for our care sites and care teams. 45 We have real-time and complete electronic patient information for our doctors at the point of care. 46 23
  • 24. 5/9/2012 We have real-time information about most current medical science and best practices available for our doctors and care teams at the point of care. 47 48 24
  • 25. 5/9/2012 49 We also now have the data needed to track care and to do real-time medical research and process improvement. 50 25
  • 26. 5/9/2012 We have completely linked our care delivery facilities -- with paperless lab reports, electronic transmissions of tests, and electronic care reporting for our hospital and medical care. 51 We probably have the lowest insurance related administrative costs of any health plan in America. 52 26
  • 27. 5/9/2012 We have the best patient/doctor connectivity -- through our electronic connections to our patients. 53 We win just about every quality award in America. 54 27
  • 28. 5/9/2012 Top HEDIS scores in 21 categories. 55 Medicare rated 459 health plans -- using 53 quality and service measures. 56 28
  • 29. 5/9/2012 Health plans were rated from one to five stars. 57 Only nine health plans in America earned five stars. 58 29
  • 30. 5/9/2012 Five Kaiser Permanente Regions won the full five stars -- and our lowest score for any KP Plan was 4.5 stars. 59 We won the “Star Wars” for Medicare. 60 30
  • 31. 5/9/2012 We were also rated number one as a health plan by J.D. Power & Associates. 61 You can look up our consumer ratings. 62 31
  • 32. 5/9/2012 The tool kit works. 63 Team Care Works Reduced broken bones by 43% Reduced HIV deaths to half the national average Reduced heart disease deaths by 30% 64 32
  • 33. 5/9/2012 We also have set up important programs to support safe care. 65 Sepsis kills more patients in American hospitals than cancer, heart disease or stroke. 66 33
  • 34. 5/9/2012 We put data supported team care in place for our sepsis patients -- and we cut the death rate from sepsis by more than half. 67 Sepsis Hospital Mortality Rates 0.25 0.2 0.15 0.1 0.05 0 39934 40756 39814 39845 39873 39904 39965 39995 40026 40057 40087 40118 40148 40179 40210 40238 40269 40299 40330 40360 40391 40422 40452 40483 40513 40544 40575 40603 40634 40664 40695 40725 40787 40817 Source: Joint Commission Journal on Quality and Patient Safety, November 2011 68 34
  • 35. 5/9/2012 If the rest of America had that same Kaiser Permanente sepsis response program in place, that would have saved 72,000 lives in America last year -- and reduced eight million very expensive hospital days. 69 Likewise -- with hospital acquired pressure ulcers -- focused science based team care can make a huge difference. 70 35
  • 36. 5/9/2012 Roughly 2.5% of patients in American hospitals get pressure ulcers -- and many patients are damaged and killed by those ulcers. 71 Team care at Kaiser Permanente has reduced pressure ulcers by two thirds. 72 36
  • 37. 5/9/2012 Hospital-Acquired Ulcers (HAPU) Stage 2 Plus All KP Hospitals CalNOC Average 4.0% CalNOC (2008) Average 3.5% 3.0% KP Average 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Q208 Q308 Q408 Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410 Q111 Q211 Q311 Q411 CalNOC consists of a coalition of California hospitals who are working together on patient safety issues. 73 Having extensive and available data about care facilitates both care improvement and care quality improvement agendas 74 37
  • 38. 5/9/2012 Our Board of Directors focuses on quality as a major part of our governance process. 75 Our Kaiser Permanente Board of Directors Quality Committee meets more often and longer than our Board Finance Committee or our Executive Committee. 76 38
  • 39. 5/9/2012 We provide the KP Board and senior leadership with a monthly update on more than 200 measures of safety and quality. The Big Q 77 The Big Q report is available to any Board member at any time by electronic reporting. 78 39
  • 40. 5/9/2012 -- We Steer Toward Quality -- •Health Plan Quality •Quality Management •Healthcare Analytics •Resource Stewardship •Patient Safety •Risk Management •Performance Improvement •Service Quality •Population Health 79 80 40
  • 41. 5/9/2012 HEDIS National 90th Percentile 81 Archimedes • KP also invests in leading edge technology such as Archimedes. • Archimedes is a person specific computer simulation model used to understand the likely health outcomes and costs of decisions from the policy level to individual patient decisions. • Archimedes is now assisting the European Health Checks project. • Targeted health checks for individuals at the highest risk are cost-effective. 82 41
  • 42. 5/9/2012 We focus on quality and we use our systems to support our quality improvement efforts. 83 We also focus on connectivity. 84 42
  • 43. 5/9/2012 Our website -- KP.org -- was used a hundred million times by our members and patients last year. 85 We started connecting with our members on the internet in large scale efforts five years ago. Our member website -- KP.org -- was used more than a hundred million times last year. 86 43
  • 44. 5/9/2012 Our patients can use the internet to: See their medical record Make appointments E-mail their doctors Order prescription refills Learn about their health or care 87 We sent out 60 million lab results electronically last year. 88 44
  • 45. 5/9/2012 We believe that up to 40% of face-to-face patient visits might be done electronically. 89 We now do 40% of our dermatology visits with video links and e-connectivity. 90 45
  • 46. 5/9/2012 Our new Android and iPhone app had nearly two million uses in the first month. 91 New Mobile Apps 92 46
  • 47. 5/9/2012 Patients love being connected. 93 So where do we go from here? 94 47
  • 48. 5/9/2012 The Four Sites of Care We believe that care in the future will be delivered in four distinct “sites of care.” 95 Site One -- Staffed Beds Hospitals Nursing homes Places where people sleep and care is delivered. 96 48
  • 49. 5/9/2012 Site one will be incredibly and increasingly well supported with great technology. 97 Site Two -- Face-to-Face Clinics, Offices Direct ambulatory caregiver encounters Exam rooms Wide array of care sites (Offices, work places/ vans / etc.) 98 49
  • 50. 5/9/2012 Site two will also be incredibly and increasingly well supported with great technology. 99 Site two technology will be diagnostic, therapeutic, communicative and remediative -- with full EMR connectivity and care linked to patient specific care plans. 100 50
  • 51. 5/9/2012 Site Three -- In-Home Care The home will be a primary site of care. Care tools will be on-site in many people’s homes. 101 Site three will be incredibly and increasingly well supported with great technology. 102 51
  • 52. 5/9/2012 Some site three technology for in- home care two years from now will be as good or better than actual hospital inpatient technology was five years ago. 103 In-home monitoring, EKGs, ultrasounds, video conferences, blood and fluid diagnostic and testing tools and patient communication tools will be increasingly sophisticated, effective, and cheap. 104 52
  • 53. 5/9/2012 For most people, the home will be the primary site of care -- very well equipped to be a great site of care. 105 In-home care will function best in the context of a care team who knows the patient’s total situation and full set of care needs. 106 53
  • 54. 5/9/2012 Site Four -- The Web The internet will deliver a lot of care Connected, web-located care will expand rapidly Web care will be available everywhere, all of the time. 107 Site four will also be incredibly and increasingly well equipped with great technology and tools. 108 54
  • 55. 5/9/2012 Portable EKGs Care tracking Electronic consults Perpetual monitoring -- linked to interventions. 109 Full data flow for each patient Interactive diagnostic work and care planning. 110 55
  • 56. 5/9/2012 Entirely current, complete patient specific care data -- at a very low cost. 111 The world is now flat for a lot of care. 112 56
  • 57. 5/9/2012 Next steps? Continuous learning will be the future of health care. 113 DNA and Causality Research 114 57
  • 58. 5/9/2012 Research Question: When mothers have a uterine infection during pregnancy -- does that create higher asthma risk for their kids? 115 Answer: YES The asthma risk is a lot higher for the kids. 116 58
  • 59. 5/9/2012 How much higher? African American kids 98% increase Source: Archives of Pediatric and Adolescent Medicine 117 How much higher? Hispanic kids 70% increase Source: Archives of Pediatric and Adolescent Medicine 118 59
  • 60. 5/9/2012 How much higher? Caucasian kids 66% increase Source: Archives of Pediatric and Adolescent Medicine 119 How much higher? Asian American kids ??? Source: Archives of Pediatric and Adolescent Medicine 120 60
  • 61. 5/9/2012 How much higher? Asian American kids Zero % increase Source: Archives of Pediatric and Adolescent Medicine 121 There was no additional risk for Asian American kids. 122 61
  • 62. 5/9/2012 African Americans 98% increase Hispanics 70% increase Caucasians 66% increase Asian/Pacific Islanders 0% increase Source: Archives of Pediatric and Adolescent Medicine 123 KP is currently collecting DNA data. 200,000 samples -- stored in Berkeley. 124 62
  • 63. 5/9/2012 Chronic Care Patients All Patients: My health care data should be used to help improve the care of future patients who might have the same or similar conditions. Agree: 89% Strongly Disagree: 3% 125 One use of that data will be to figure out what might be a genetic factor for the asthmatic kids. 126 63
  • 64. 5/9/2012 Electronic data lets us discover unexpected linkages and unsuspected causalities. 127 Alzheimer’s Research High 260% higher (longitudinal cholesterol Alzheimer’s rate data -- long time in 30s in 70s members) Hypoglycemic 80% higher rate (two attacks -- of Alzheimer’s 160% higher attack pre-60s in 70s rate) 172% increased Heavy smokers 157% increased risk of vascular risk of in mid life dementia two Alzheimer’s decades later (EMR Applied to Longitudinal Research) 128 64
  • 65. 5/9/2012 Autism Studies 30% Higher for older mothers 50% Higher for older fathers 129 The risk of autism for children was three times higher when the mothers to be took a particular drug in the first trimester of pregnancy and twice as high if the mother took that same drug in the second trimester. 130 65
  • 66. 5/9/2012 Which trimester is the higher risk? 131 No one suspected any link between that drug and Autism -- until the Kaiser Permanente study was done. 132 66
  • 67. 5/9/2012 Kaiser Permanente patient data resulted in Vioxx being removed from the marketplace. 133 We need electronic data. 134 67
  • 68. 5/9/2012 We need electronic data to improve care. 135 We need electronic data to improve science. 136 68
  • 69. 5/9/2012 We need electronic data to save lives. 137 We need electronic data to link caregivers. 138 69
  • 70. 5/9/2012 So Kaiser Permanente is building a tool kit and learning to use the new tool kit to make care better, safer, more accessible, smarter, and less expensive. 139 We spent four billion dollars at KP on computer based care support tools. 140 70
  • 71. 5/9/2012 Our annual cost and expense level is more than five billion dollars a year below where it would be if we did not have those tools. 141 It’s a good time to use computers to support care. 142 71