Why would a physician and a health system executive be interested in transportation? A conversation with nationally recognized Arlington, VA Mobility lab, and myself and Keith Montgomery, Executive Director of the Center for Total Health
Transportation and Total Health - Arlington Mobility Lab Lunch and Learn
1. Transportation and Total Health
Lunch at the Lab • October 10, 2013
Ted Eytan, MD, Physician Director • Keith Montgomery, Executive Director
Kaiser Permanente Center for Total Health, Washington, DC USA
Photo: M.V. Jantzen - http://www.flickr.com/photos/mvjantzen/8464490630/
2. Transportation and Total Health
Lunch at the Lab • October 10, 2013
Photo: Ted Eytan, MD - http://www.flickr.com/photos/22526649@N03/9720976367
3. We’re here from the future
Kaiser Permanente Center for Total Health • @kptotalhealth
6. §24/7 access worldwide
§9,000,000 members can
–email their doctor
–check lab test results
–order prescription refills
–manage appointments
§iOS, Android, Blackberry
patient |
st
21
century
9. Health happens here
La Mesa Medical Offices, California
Photograph: Ted Eytan, MD, http://www.flickr.com/photos/taedc/8382776635/
10. The most HEDIS #1’s
Effectiveness of Care Measures
41
Kaiser Permanente #1’s
• Comprehensive diabetes
31
21
10
2011
9
0
Medicare
care — LDL control less than
100 mg/dl (Hawaii Region)
• Osteoporosis management
in women who had a fracture
(Northern California Region)
• Breast cancer screening,
age 42–69 (Northwest
Region)
• Pharmacotherapy
Management of chronic
obstructive pulmonary
disease (COPD)
exacerbation —
bronchodilator (Northwest
Region)
• Cholesterol management
(coronary artery disease),
LDL level less than 100 mg/
dl (Colorado Region)
• Follow-up after
hospitalization for mental
illness — 30 days (Colorado
Region)
• Controlling high blood
pressure — cardiovascular
(Hawaii Region)
• Potentially harmful drugdisease interaction — total
(Hawaii Region)
• Weight assessment for
adults — body mass index
percentile (Georgia Region)
• Weight assessment for
11
Commercial
children — body mass
index percentile
• Counseling for nutrition
for children
• Counseling for physical
activity for children
• Chlamydia screening in
women (ages 16–20,
21–24 and total)
• Appropriate testing for
children with pharyngitis
• Appropriate use of
medications for people
with asthma (ages 12–
50, total)
• Comprehensive diabetes
care — LDL control less
than 100 mg/dl
• Comprehensive diabetes
care — medical attention
for nephropathy
• Antidepressant
medication management
(effective acute phase)
• Antidepressant
medication management
(effective continuation
phase)
• Annual monitoring for
patients on persistent
medications —
anticonvulsants
11. The most HEDIS #1’s
Effectiveness of Care Measures
Kaiser Permanente #1’s
• Breast cancer screening,
41
31
21
10
2012
13
0
Medicare
Source: Kaiser Permanente Newe Center, http://xnet.kp.org/
newscenter/pressreleases/nat/
2012/101012_ncqa_care_measures.html ; http://xnet.kp.org/
newscenter/pressreleases/nat/2012/112812-ncqa-medicaremeasures.html
age 42–69 (Southern
California)
• Use of Spirometry Testing in
the Assessment of COPD
(Hawaii Region)
• Pharmacotherapy
Management of COPD
Exacerbation —
Bronchodilator (Southern
California)
• Cholesterol management
(coronary artery disease),
LDL Screening (Hawaii)
• Cholesterol management
(coronary artery disease),
LDL level less than 100 mg/
dl (Colorado)
• Controlling high blood
pressure — cardiovascular
(Ohio)
• Comprehensive diabetes
care — HbA1c Testing
(Hawaii)
• Comprehensive diabetes
care — LDL level less than
100 mg/dl (Northern
California)
• Comprehensive diabetes
care — Medical Attention for
Nephropathy (Colorado)
• Comprehensive diabetes
care — blood pressure
control (<140/80) (Georgia)
• Comprehensive diabetes
care — blood pressure
control (<140/90) (Colorado)
• Osteoporosis management
in women who had a fracture
(Southern California)
• Potentially harmful drugdisease interaction —
Dementia (Hawaii)
16
Commercial
• Breast cancer screening
• Comprehensive diabetes
care — blood pressure
control (<140/80)
• Comprehensive diabetes
care — blood pressure
control (<140/90)
• Comprehensive diabetes
care — medical attention
for nephropathy
• Antidepressant
medication management
(effective acute phase)
• Antidepressant
medication management
(effective continuation
phase)
• Weight assessment for
children — body mass
index percentile
• Counseling for nutrition
for children
• Counseling for physical
activity for children
• Chlamydia screening in
women (ages 16–20,
21–24 and total)
• Appropriate treatment for
children with upper
respiratory infection
• Avoidance of antibiotic
treatment in adults with
acute bronchitis
• Use of spirometry testing
in assessment &
diagnosis of chronic
obstructive pulmonary
disease
• Annual monitoring for
patients on persistent
medications —
anticonvulsants
• Medical assistance with
smoking cessation —
advising smokers to quit
• Medical assistance with
smoking cessation —
discussing strategies
12. The most HEDIS #1’s
Effectiveness of Care Measures
2013
Kaiser Permanente #1’s
41
• Adult BMI Assessment
• Weight Assessment for
31
21
13
10
0
Medicare
Source: KP Share, http://share.kaiserpermanente.org/article/kaiserpermanente-leads-the-nation-in-13-commercial-health-plan-qualitymeasures/
Commercial
Children
• Counseling for Nutrition
for Children
• Counseling for Physical
Activity for Children
• Breast Cancer Screening
• Cervical Cancer
Screening
• Chlamydia Screening in
Women (Ages 16-20,
Ages 21-24, and Total)
• Use of Spirometry
Testing in Assessmand &
Diagnosis of COPD
• Controlling High Blood
Pressure
• Comprehensive
Diabetes Care - Eye
Exams
• Comprehensive
Diabetes Care - Medical
Attention for
Nephropathy
• Comprehensive diabetes
care — blood pressure
control (<140/80)
• Comprehensive diabetes
care — blood pressure
control (<140/90)
13. What will happen with diabetes?
Pre-diabetes
20131
852,301
52% develop diabetes
29% develop
over 10 over
diabetesyears23
years2
New cases of diabetes by
2016
247,167
members with type 2 DM
in 20123
477,383
New cases of diabetes by 2023
443,197
1 – Preliminary data; Care Management Institute Analysis March 2013.
2 – Diabetes Prevention Research Group; Diabetes Prevention Program
3 – Preliminary data; CMI Analysis, as of March 31 2012. CORE KP HEDIS Diabetes cohort, minus expected % of
Type 1 diabetes per CDC national prevalence
14.
15. If physical activity were a drug...
activated
activated
activated
deactivated
it works
Source: Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nature Reviews. Neuroscience. 2008;9(1):58–65..
Slide created by Ted Eytan, MD | @tedeytan | December, 2012
tm
better
17. Exercise as Vital Sign
§ “I would suggest it makes more
sense to stop measuring blood
pressure at every visit than to
ignore our patient’s exercise
habits, because we know that
being sedentary is a bigger risk
factor for mortality than mild to
moderate levels of
hypertension”
– Bob Sallis, MD
Source: Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign.
Br. J. Sports Med. 2011;45(6):473–474. Available at: http://bjsm.bmj.com/content/45/6/473.short.
Smith, John W
19. It’s not just me
Bob Sallis, MD and Matt Sallis
Rosemary Agostini, MD
20. Our patients notice
“Kaiser (Permanente) is so far past faxing orders that
they’re into sustainable apples”
-Jess Jacobs, April, 2013, TEDMED
http://http://jessjacobs.me/my-intravenous-lecture/
28. An integrated approach
to total health and productivity @ the Worksite
Manage
employees’
current health
conditions
Understand
their health risks
Health Plan and Medical Group
1
Encourage
employee
health
Prevent
future
costs
29. Reports:
Prevention and lifestyle dashboard
Your Results,
2008 Q4
Your Results,
2009 Q3
Year-Over-Year
Change
Measure
BMI: weight management
% of adult members who are
overweight or obese
73.4%
73.6%
Declined
Cholesterol management
% of members borderline high or
high total cholesterol
36.3%
36.8%
Declined
Blood pressure management
% of members with blood pressure
>=140/90
11.3%
11.6%
Declined
Smoking rates
% of members who smoke
12.8%
12.4%
Improved
Breast cancer screenings*
% of eligible population screened
85%
86.7%
Improved
Cervical cancer screenings*
% of eligible population screened
86%
85.6%
Declined
Colorectal cancer screenings*
% of eligible population screened
64.9%
63.6%
Declined
Childhood immunization rates*
% of eligible population screened
85.2%
81.3%
Declined
Childhood obesity
*
Description
% of child members who are
overweight or obese
35.9%
36.2%
Declined
Continuously enrolled members during measurement period. Insufficient sample size (ISS) will be displayed if the number of
eligible members for the prevention measure falls below 30.
2
34. Exercise = better health and lower costs
Only 5% of Americans exercise regularly*
Each year, inactive people can cost you:
5%
$323
$4,927
More in
absenteeism
costs
7
$622
More
in direct
medical
costs
More in
health costs
for chronic
conditions
35. Log on for a healthier workforce
Online
Physical
Activity
Program
8
36. Beyond HealthWorks
• Community Benefit
• Thriving Schools, Fire Up Your Feet
• Walking Summit – October 1-3
• 100+ partners
• 20 partners in “Share Fair”
• 400 total attendees
• Digital Health Technology Exploratorium
• 3 formal walking meetings
• 12 capacity building sessions
• Proposed call to action by the Surgeon
General
9