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© 2013 The Permanente Federation LLC
Kaiser Permanente Virtual Site Visit IHI National Forum
December 9, 2013
Jack Cochran, MD, Executive Director, The Permanente Federation
Alide Chase, SVP, Medicare Clinical Operations and Population Care
2
Session Objectives
Extract key elements from Kaiser’s journey that could be applied to your system.
Identify a "best practice" that can be brought back to your organization.
Consider proposition of excellence not being good enough, and determine the need to shift from celebration to acceleration.
2
Agenda
3
Kaiser Permanente Overview
Quality Journey
Break
Physician Leadership and Engagement
Break
Total Health
Part 1: Kaiser Permanente Overview
4
3
About Kaiser Permanente
We are the nation's largest not-for-profit health plan
Based on an integrated health care delivery system
Dedicated to care innovations, clinical research, health education, and the support of community health
Composed of three entities
Kaiser Foundation Health Plan
Kaiser Foundation Hospitals
Permanente Medical Groups
5
Our Numbers
Kaiser Permanente is the nation’s largest not-for-profit integrated health care delivery system serving 9.1M members across 8 states.
37M+ office
visits per year
Over 16,000 doctors
and 48,000 nurses
9+ Million members
38 Hospitals and over
600 medical office
buildings
6
4
Permanente Medical Groups
Kaiser Foundation Health Plan
Kaiser Foundation Hospitals
Member/Patient
Kaiser Permanente: An Integrated Care Delivery System
7
Our Mission
To provide high-quality,
affordable health care
services and to improve
the health of our
members and the
communities we serve.
8
5
…and accountability across the care continuum.
Primary
Prevention
Secondary
Prevention
Acute
Care
Chronic
Care
A Systematic Approach
9
PATIENT
Primary Care
Physician Registered
Nurse
Specialist
Case Manager
Mental Health
Outreach
In-reach
Skilled Nursing Facility
Home Health
Hospital
Medical Office
Pharmacist
Health Educator
Coordinated, Patient-Centered Care
10
6
Creating a Better Future
11
America’s Best Medicare Health Plans
1. Kaiser Foundation Health Plan of Southern California
2. Kaiser Foundation Health Plan of Northern California
3. Kaiser Foundation Health Plan of the Northwest
4. Kaiser Foundation Health Plan of Colorado
5. Kaiser Foundation Health Plan of Hawaii
6. Capital Health Plan
7. Geisinger Health Plan
8. Kaiser Foundation Health Plan of the Mid-Atlantic States
9. Capital District Physicians’ Health Plan
10. Security Health Plan of Wisconsin
Source: NCQA: America’s Best Health Insurance Plans (Medicare) 2013-2014
12
7
Kaiser Permanente’s Key Success Factors
Clear, agreed upon, mission
Clinical leadership
Culture of measurement, comparison, acknowledgement, learning, and improvement
Aligned structure and incentives
Integrated information technology
13
Part 2: Quality Journey
14
8
What Would a Transformed Organization Look Like?
A place where
the patient’s voice is heard and drives design
physicians and staff experience reward and joy in their work
there is a lean, judicious use of resources
there is continuous learning
goals for affordability, quality and service are achieved
15
THE WILL
Understanding and
acknowledging reality
EXECUTION
Macro System
Meso and Micro
System
The Kaiser Permanente Quality Journey
IDEAS Working top down and
bottom up
Macro
System
Meso and Micro
System
16
9
Transforming Quality and Service is a Challenge
Lessons Learned:
Seek support/Begin a social movement – the journey is
long and hard
Ambitious vision & real plan to drive faster
improvement
System level measures prompt transformation
Redesign care across complex systems
Leaders find themselves in new roles and working
differently (and happier)
Rebuilding the infrastructure and improvement
capabilities needs substantial attention
Not for the faint of
17
IHI Seven leadership points to leverage
1. Establish and oversee specific system-level aims at the highest governance level
2. Develop an executable strategy to achieve the system-level aims and oversee their execution at the highest governance level
3. Channel leadership attention to system-level improvement: Personal leadership, leadership systems and transparency
4. Put patients and families on the improvement team
5. Make the chief financial officer a quality champion
6. Engage physicians
7. Build improvement capability
18
10
Establish System-Wide Aim at the Highest Governance Level "Our goal as an industry, and my goal at Kaiser Permanente, must go
beyond slowing the rise in health care costs. We need to drive costs
down. Accomplishing this goal will not only benefit our current and future
members, it will also contribute to driving America toward a healthier,
more sustainable and more sensible health care delivery system. That's
good for the country and for every single American.”
- Bernard Tyson, CEO, Kaiser Foundation Health Plan and Hospitals
"We need to make health care a “Learning Industry.” The inflection point
won’t come from one bright leader or one superb organization ... We can
only achieve this inflection point by being interconnected, by working
collaboratively, by learning together. We can’t treat our way out of this
crisis, we must learn our way out of it.”
- Jack Cochran, MD, Executive Director, The Permanente Federation
19
Whole System Measures:
Patient Safety
Service
HSMR
Equitable Care
Year 1 Year 2 Year 3
2 Regions hit
patient Safety
Target
3 Regions hit
patient Safety
Target
4 Regions hit
patient Safety
Target
Inpatient @ 85th
Percentile; Outpatient
@ 90th Percentile in 7
of 8 regions
Inpatient @ 85th
Percentile; Outpatient
@ 90th Percentile in 8
of 8 regions
Inpatient @ 90th
Percentile; Outpatient
@ 90th Percentile in 8
of 8 regions
Maintain HSMR
below US
Medicare
Maintain HSMR
below US
Medicare
Maintain HSMR
below US
Medicare
Decrease the
gap by 25%
Decrease the
gap by 25%
Decrease the
gap by 25%
20
11
Establish and Measure Multi-Year Whole System Goals
Be transparent with performance across the organization
Celebrate high performers
Be attentive to low performers
Create a multiyear approach
Aligns with accountabilities and incentives
21
Confidential and Proprietary - Internal Use Only - Do Not Distribute
Value Focus and Core Strategies Guided by the mission and
vision, we have renewed our
focus priorities to create the
health care value our members
and communities expect and
deserve. We will create this
value by employing core
strategies in ways unique to
KP. This strategic plan
presents KP performance and
demonstrates our approach to
caring for our members and
communities through
examples and descriptions of
how we will lead health care
transformation.
Total Health
Experience
Safety
Affordability
Quality Care
Focus on Value
Provide Expert Evidence-Based Care
Core Strategies
Activate all Levers for Total Health
Empower and Personalize
Innovate Care to Enable Access Anywhere
Work Together Seamlessly
Transforming Health Care
22
12
Ambulatory Service Performance: Health Care Rating
Tremendous Improvement in Member Satisfaction with the Health Care they Receive
Legend: Blue = Program trend
Black = benchmark
% o
f re
spondents
rating a
ll h
ealth c
are
in last
year
as, 9, or
10
on a
scale
of 0 to 1
0 (
from
wors
t possib
le t
o b
est possib
le)
>>
Drivers
• Focus on leadership
• Alignment of goals
• Engagement of front-line
Key Initiatives
• Access improvement practices
• Communications
• Culture of Excellence
75th percentile
23
Great Progress on Hospital Service Hospital Service Performance: Overall Hospital Satisfaction
% o
f re
spondents
rating their
hospital sta
y in last year
as 9
or
10
on a
scale
of 0 to 1
0 (
from
wors
t possib
le t
o b
est possib
le)
>>
Key Initiatives
• Senior Leader Rounding
• Nurse Leader Rounding on Patients Daily
• Hourly Rounding
Drivers
• Focus on leadership
• Alignment of goals
• Engagement of front line
• NKE Behaviors
• Communication Modules
• Culture of Excellence
Legend: Blue = Program trend
Black = benchmark
24
13
65.0%
70.0%
75.0%
80.0%
85.0%
2009 Q4 2010 Q1 2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4
HEDIS 2011 (PY Year 2010) HEDIS 2012 (PY Year 2011) HEDIS 2013 (PY Year 2012)
Leveraging the Power of Electronic Health Records: Improved Ambulatory Care
Ambulatory Performance: HEDIS Composite
(PY Year 2009)
>>
PY = Performance Year
% o
f eligib
le m
em
bers
receiv
ing a
ppro
pri
ate
am
bula
tory
care
65.0%
70.0%
75.0%
80.0%
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
HEIDS
2007
HEDIS 2008 (PY Year 2007) HEDIS 2009 (PY Year 2008)
KP Rate 90th Percentile 75th Percentile
Drivers
• Population care
• Decision support
• KP.org
HEDIS 2010
25
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
2009 Q4 2010 Q1 2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4
HEDIS 2011 (PY Year 2010) HEDIS 2012 (PY Year 2011) HEDIS 2013 (PY Year 2012)
Dramatic Improvement in Colorectal Cancer Screening
Ambulatory Performance: Colorectal Cancer Screening
Drivers
• Utilization of FOBT test kits
• Interactive Voice Recording
• Education and awareness
• KP HealthConnect
>>
% o
f eligib
le m
em
bers
receiv
ing a
ppro
pri
ate
am
bula
tory
care
65.0%
70.0%
75.0%
80.0%
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
HEIDS
2007
HEDIS 2008 (PY Year 2007) HEDIS 2009 (PY Year 2008)
KP Rate 90th Percentile 75th Percentile
PY = Performance Year
(PY Year 2009)
HEDIS 2010
26
14
70.0%
75.0%
80.0%
85.0%
90.0%
2009 Q4 2010 Q1 2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4
HEDIS 2011 (PY Year 2010) HEDIS 2012 (PY Year 2011) HEDIS 2013 (PY Year 2012)
Continuing to Lead in Cardiovascular Care
Ambulatory Performance: Cardiovascular Care Subscale
Drivers
• Panel management
• Alignment with goals
>>
% o
f eligib
le m
em
bers
receiv
ing a
ppro
pri
ate
am
bula
tory
care
65.0%
70.0%
75.0%
80.0%
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
HEIDS
2007
HEDIS 2008 (PY Year 2007) HEDIS 2009 (PY Year 2008)
KP Rate 90th Percentile 75th Percentile
PY = Performance Year
(PY Year 2009)
HEDIS 2010
27
70.0%
75.0%
80.0%
85.0%
2009 Q4 2010 Q1 2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4
HEDIS 2011 (PY Year 2010) HEDIS 2012 (PY Year 2011) HEDIS 2013 (PY Year 2012)
Steady Improvements in Diabetes Care Leading to Benchmark Performance
Ambulatory Performance: Diabetes Care Subscale
Drivers
• Panel management
• Alignment with goals
Completed introduction of
Performance Improvement
Network Calls (2006-2009)
>>
% o
f eligib
le m
em
bers
receiv
ing a
ppro
pri
ate
am
bula
tory
care
65.0%
70.0%
75.0%
80.0%
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
HEIDS
2007
HEDIS 2008 (PY Year 2007) HEDIS 2009 (PY Year 2008)
KP Rate 90th Percentile 75th Percentile
PY = Performance Year
(PY Year 2009)
HEDIS 2010
28
15
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
1.1
1.2
Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2008 2009 2010 2011 2012
KP - All Facilities
US Medicare Overall
Kaiser Foundation Hospital
Dramatic Reduction in Risk Adjusted Hospital Mortality
Ra
tio
of
ob
se
rve
d t
o e
xp
ec
ted
mo
rta
lity
Inpatient Outcomes: Hospital Standardized Mortality Ratios
>>
29
Most
Appropriate
Setting
Reduce
Hospital
Mortality
No Needless
Harm
Reduce Overall
Admits and
Readmits
Preventable
Deterioration
Aim
Primary Drivers
Secondary Drivers Selected Initiatives
Sepsis Initiative
Sedation and Ambulation
Protocols
Blood Stream, C Diff, MRSA
Infection Reduction
Falls and Hospital
Acquired Pressure Ulcers
Perinatal Outcomes
Antibiotic Stewardship
Healthy Bones
Disease Programs
Readmission
Diagnostic
Transition Bundle
Throughput: Ed, OR
Palliative Care
SNF Rounding
Preventable
Harm
Preventable
Complications
Population and
Chronic Care
Programs
Reliable and
Safe
Transitions
Life Care
Planning
Home and
Continuum
Capacity
Inpatient Mortality Reduction Driver
30
16
7%
35%
Progress on Key Indicators: 2008 - 2012
36%
Hospital
Standardized
Mortality Ratio
BSI Rolling
12 Mo. Rate HAPUS Readmissions RFO
20%
Worker
Injury
Rates
Inpatient
Utilization
21%
54%
Cdiff
82%
30%
SRAES
19%
P31
225
250
275
300
325
350
Inp
atie
nt
Day
s p
er 1
000
Mem
ber
ship
s
Year and Month
Inpatient Days per 1000, 2010Jun-2013Jun All Lines of Business, All Regions, Unadjusted
Source: Inpatient Days per 1000 report, National Inpatient Analytic
Significant Reduction in Use of Inpatient Beds National Patient Day Rate
32
17
Continuous Improvement System Execution in a System
Manage Local
Improvement
Develop
Capability
Spread and sustain Provide Leadership for
Large system Projects
Provide Day-to-Day
Leaders for Micro Systems
Source: IHI 2008
Define
Breakthrough
Goals
33
Dev
elo
p a
nd
Tes
t th
e S
yste
m
at a
F
acili
ty l
evel
Implementation of KP’s PI System: Planning to Achieve Big Results Over Time
Exp
and
Im
pro
vem
ent
syst
em t
o
mo
re d
epar
tmen
ts
Dee
pen
im
pro
vem
ent
kno
wle
dg
e
wit
hin
ser
vice
s an
d u
nit
s
Learning and sharing systems regionally and program-wide Improvement Institute
Portfolio Whole
system
Continuous Improvement Project
Level of Project
Difficulty
• Service line IA’s
• All leaders know role
and skills
• Prioritization and
oversight in operations
• Alignment of portfolios
• Standard work
• Teams know goals and
test change
• Several Improvement
Advisors
• Prioritization and
portfolios
• Oversight groups
• Sponsor and champion
accountability by service
• Team development and
alignment of goals
• Improvement Advisor
• Leadership
• First project
• Oversight responsibility
• Several teams
• 90 days
Mentors
34
18
Discussion
What do you see as the barriers to achieving
excellence?
What big, clear goals have your leaders set
out?
35
Break: 10 minutes
36
19
Part 3: Physician Leadership and
Engagement
37
“Our greatest
responsibility is
to be good
ancestors.”
- Jonas Salk
38
38
20
Is Excellent Good Enough?
39
US Spending as Percent of GDP
Source: The Economist Pocket World in Figures, 2013 Edition
Education Defense Health Care
2010
1960 2010 1960 2010 1960 2010
6% 6%
6% 6% 6% 6% 6% 5%
18%
40
21
Meet Teacher Dan
Salary increase 2002 – 2012
Inflation
Health benefit contribution increase
Actual salary change
$7,300
-$15,418
-$4,296
-$12,414
41
Affordability
Workforce shortages
Career Sustainability
Patient focus
Technology
Health reform
Aging population
Economic crisis
Critical Confluence
42
22
A Fundamental Shift
43
HealthBarometer 2011 19
17%
22%
24%
29%
31%
45%
55%
62%
65%
72%
75%
77%
81%
88%
A celebrity
CEO
Regular employee
Journalist or reporter
Government official/regulator
NGO representative
Friend or family member
Health or science expert in a company
Someone living with a disease or conditIon
Academic or expert on a health issue
Nutritionist or dietician
Nurse
Pharmacist
Doctor
Q106 - 119. Below is a list of people. In general if you heard health-related information from that person, how credible do you think that information would be - extremely credible, somewhat credible, neither credible nor incredible, not very credible or not credible at all? (Global) (Top 2 Box – Credible = Extremely Credible/Somewhat Credible)
Expertise, experience and authenticity are required for credibility
Expertise
Authenticity
Experience
Doctors Are Trusted
Most credible sources for health-related information
44
23
Doctors Are Dissatisfied
68% Feel Negative about
the Current State of the Medical
Profession
77% Feel Negative about
the Future of the Medical
Profession “A Survey of America’s Physicians: Practice Patterns and Perspectives”
The Physician’s Foundation, September 2012
45
Doctors Don’t Believe They Are Responsible for Health Care Costs
2012 Physician Survey: Who has major responsibility for
reducing health care costs?
“Views of US Physicians About Controlling Health Care Costs”
JAMA, July 24, 2013
46
24
Why Should Physicians Lead Health Care Transformation?
47
Clear Values
&
Expectations
Defining and Creating the Culture
Recruit
Orient
Develop
Evaluate
Promote
48
25
Leadership Styles & Actions
BEST CAREER
People, Culture
BEST CARE & VALUE
Quality, Service,
Cost
BEST SOLUTION
Safe, Equitable,
Accessible, Affordable
49
Healer
Leader
Partner
50
26
Leadership Traits
Integrity
Highly respected clinician
Emotional intelligence
Enterprise ownership
Passion
51
Leadership Expectations
Performance
Communication
Learning
Resolve
52
27
Value Dissent
Challenge Cynicism
53
Clarity
Consistency
Collaboration
Compassion
Courage
54
Leadership Behaviors
28
55
Companies should create conditions for people to find the joy in work itself
56 56
29
To us, leadership is everyone’s business. Leadership is not about a position or a place. It’s an attitude and a sense of responsibility for making a difference.
Kouzes and Posner
57
A Fundamental Shift
58
30
Templates & Information
Technology & Tools
Teams
59
Asking New Questions
How many patients can you see?
How many patients’ problems can you solve? How can we encourage and convince patients to get required prevention? How can we create systems that significantly increase that patients get required prevention?
How often should a physician see a patient to optimally monitor a condition? What is the best way to optimally monitor a condition?
From
To
From
To
From
To
60
31
Physician Engagement in HIT Development and Deployment: The Kaiser Permanente “Collaborative Build”
61
Successful Rapid Roll-out of EHR
EHR deployed with full functionality to 5,000+ users in 4 weeks!
27,000 hours of training over two months
Majority of physicians back to full schedules 30 days after their initial go-live
“Welcome to the starting line!”
62
32
Day
Tota
l OS
S b
y S
up
po
rt G
rou
p
Physician Leadership during EHR Implementation
in Kaiser Permanente Colorado On-Site Support Run Rate
12 18 33
41 47 54 61 65 74 77 70 68
60 56 51 48 48 45 39 38 33 29 22 18 17
14
30
30 30
30 30
30 30
30 30 30 30
30 30
30 30 30 30 30 30
30 30
30 30 30
25 25
35 35 35
35 35 35
35 35 35 35 35
35 30 30
30 30
25 10 2
6
26
34
27
41
48 48 45 58 55
63 54
51 53 46 52
36 33
21 12
9
3
7
0
20
40
60
80
100
120
140
160
180
200
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Leadership KPHC Project Team Supporting Epic Supporting Volunteers Supporting
63
Speed Does Not Come From Going Fast
It comes from:
Sharing context
Building capability – systems and leadership
Clearly articulating the goal(s)
Executing, to achieve early success (and to build trust)
Speed is created by the resulting momentum.
64
33
The Range of Impact of the Fully Accountable Physician
Clinical Quality
Resource Stewardship
Information Technology Systems Development and Deployment
Drug Formulary
Research
Public Policy
Insurance Product Development and Customer Engagement
65
Resist
React
Create
Transform
Victim
Incremental
Change
Innovation
Transfer
Continuous
Leaning
Coalition
66
34
Discussion
What challenges are you working through
with/as physician leaders?
67
Break: 10 minutes
68
35
Part 4: Total Health
69
Why Total Health? • Education/Literacy
• Employment
• Income
• Family and social support
San Francisco Bay Area – Kaiser Permanente Members Poverty, Diabetes and Obesity (2010)
• Community Safety
• Early Childhood
• Race and Ethnicity
Social and
Economic
Factors
70
36
We are committed to helping our members, our workforce,
their families, and our communities achieve Total Health
through the services we provide and by promoting clinical,
behavioral, environmental, and social actions that improve
the health of all people.
Total Health is a state of complete physical, mental
and social well-being for all people.
To be a Leader in Total Health by making lives better.
Kaiser Permanente Strategic Vision
71
Total Health: Support Our Members Through All Stages of Life
Returning to Health
Healthy Aging Living Well with
Chronic Conditions
Staying Healthy
Total
Health
72
37
Big Concepts
Shift from Disease Management to Population Care
Embracing Total Health
Care Transformation
Patient/Family Activation
Social and Community Activation
73
What We’re Up Against
74
38
75
What We’re Up Against
1999
Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2009
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
76
39
“I think we’re looking at a first
generation of children who
may live less long than their
parents as a result of the
consequences of overweight
and type 2 diabetes.”
The Epidemic of Overweight and Obesity
www.discoveryhealthCME.com, N Engl J Med Vol. 352(11) March 2005, pp. 1138-1145
What does it mean?
- Francine Ratner Kaufman, MD Head, Division of Endocrinology & Metabolism
Children’s Hospital Los Angeles
77
Disrupt Current Defaults …
78
40
… to Create Optimal Defaults for Total Health
79 Confidential – For Internal Use Only
Drivers of Health
80
41
Many Factors Shape Health Health is driven by multiple factors that are intricately linked –
of which medical care is one component.
Drivers of Health
Source: McGinnis et al, Health Affairs, 2002
Family History and Genetics
30%
Environmental
and Social
Factors
20%
Personal Behaviors 40%
Medical
Care
10%
81
…we are developing a more sophisticated analytical model to deepen our understanding of effective interventions.
Social & Economic
Factors
Physical
Environments
Health Outcomes
And Wellbeing
Pro
gra
ms a
nd
Po
licie
s
• Education
• Employment
• Income
• Family & social
support
• Community safety
• Culture
• Built environment
• Food environment
• Media/information
environment
• Environmental quality
Health Behaviors
& Other Individual
Factors
• Diet & activity
• Tobacco use
• Alcohol use
• Unsafe sex
• Genetics
• Spirituality
• Resilience
• Activation
Clinical Care and
Prevention
• Access to care
• Quality of care
• Clinic-community
integration
• Physiology
• Disease and injury
• Health and function
• Wellbeing
Settings: Home Workplace School Neighborhood Clinic Virtual
Adapted from County Health
Rankings, 2010 and M. Stiefel,
2012. Draft: 9/15/2012
82
42
We Must Address Health At All Levels
Deploying Kaiser Permanente Assets for Total Health
1
Neighborhood /
Community
Society
Individual /
Family
Home / School /
Worksite
Physical and Mental Health Care
“Body, Mind and Spirit”
Community
Health Initiatives
Environmental
Stewardship
Clinical Prevention
Access to
Social and
Economical
Supports
Health Education
Public Information
Public Policy
Research
and Technology
Walking
Promotion
Worksite/
Workforce
Wellness
83
Focus on Schools and Kaiser Permanente’s Workforce
84
43
Key Strategies
Peer-to-peer learning
Youth engagement
Parent & community engagement
Wellness champions at
all levels
District Leadership engagement
Primary Goal
• Improved Health
• Productivity, academic achievement, schools census as co-benefits
Focus Areas
• Healthy Eating
• Active Living
• School Climate
Targets
• Students
• Staff and teachers
• School environment
Healthy Schools: Our Aim
85
Healthy
Eating
Healthy Physical
Environment
Healthy Activity
at Work
Workforce Wellness: Where to Start
86
44
Getting our Workforce Walking
87
Areas of strongest focus for the future
88
45
The road ahead is challenging…but we can find a way.
89
90
46
Jack Cochran, MD
Executive Director
The Permanente Federation
Kaiser Permanente
(510) 271-5886
Alide Chase
Senior Vice President
Medicare Clinical Operations
and Population Care
Kaiser Permanente
(510) 271-5770
Thank You
