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The Kaiser Permanente Model
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Mountain picture
Scott Smith, MD
Associate Medical Director of Operations
Kaiser Permanente Colorado
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D E DA TSAL
Largest nonprofit health plan in the U.S. Integrated health care
delivery system 9.1 million members 16,000+ physicians
48,000+ nurses
174,000+ employees Serving 8 states and the
District of Columbia
37 hospitals
Almost 600 medical offices/ outpatient facilities
$50.6billion operating revenue*
Scope includes ambulatory, inpatient, ACS, behavioral health, SNF, home health, hospice, pharmacy, imaging, laboratory, optical, dental, and insurance
*Source: 2012 Kaiser Permanente Annual Report
Mid-Atlantic Region
Georgia Region
Colorado Region
NorthernCalifornia Region
Hawaii Region
Northwest Region
SouthernCalifornia Region
About Kaiser Permanente
Our Mission
To provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.
5
NCQA Health Insurance Plan Rankings 2013-2014 Summary Report (Medicare)
Kaiser Permanente Colorado
• 540,000 Patients, 27 Medical Offices
• 1000 Physicians
• 1 Electronic Medical Record (EMR)
• Revenue in Excess of $3 Billion USD
• Physicians Are Paid on Salaryo Up to 10% bonus based on service & quality
• Pharmacy, X-Ray, Lab in each medical office
Role of EACH Physician
LEADER
HEALER
PARTNER
Jack Cochran, MD, Executive Director, Permanente Federation
KP Colorado Primary Care Model
• 300 Primary Care Physicians• 130 General Practice• 110 Internal Medicine• 60 Pediatricians
• Roughly 1 physician per 1800 members• We register each patient with one
physician• All booking and care is directed to this physician• Patients see their personal physician 82% of the time
Primary Care – Our Triple Aim
Patient-Centered Medical Home
Link Each Patient to One Primary
New Access
TeamEnhancement
Care Doctor
Models
Quality Outreach
Population Health
Per Capita CostCare Experience
Primary Care
Team
Patient
Patients Needs Come First
Team Delivers Care
Respectful & Compassionate Care
Typical Day
Routine Access to Care is less than 4 days
15 Patients in office 3 Scheduled phone 8 Patient emails 5 Unscheduled phone45% of all patient contacts are virtual
Typical Day
QualityAll prevention needs and gaps are known
All chronic condition monitoring results and gaps are known
Centralized team outreaches to complete
Yesterday’s Care Tomorrow’s Care
Our patients are those who make appointments to see us
Our patients are those who are in our panel
Patients’ chief complaints or reasons for visit determines care
We systematically assess all our patients’ health needs to plan care
Care is determined by today’s problem and time available today
Care is determined by a proactive plan to meet patient needs without visits
Care varies by scheduled time and memory or skill of the doctor
Care is standardized according to evidence-based guidelines
Patients are responsible for coordinating their own care
A prepared team of professionals coordinates all patients’ care
I know I deliver high quality care because I’m well trained
We measure our quality and make rapid changes to improve it
It’s up to the patient to tell us what happened to them
We track tests & consultations, and follow-up after ED & hospital
Clinic operations center on meeting the doctor’s needs
A multidisciplinary team works at the top of our licenses to serve patients
Acute care is delivered in the next available appointment and walk-ins
Acute care is delivered by open access and non-visit contacts
Slide from Daniel Duffy, MD School of Community Medicine Tulsa, Oklahoma
Innovation distinguishes between a leader and a follower ---Steve Jobs
13
Let me put it simply: I
In this room, with the successes already in hand among you here, you collectively have enough knowledge to rescue (American) health care – hands
down. Better care, better health, and lower cost through improvement right here.In this room.
The only question left is: Will you do it?
When we entered the world of health care improvement as our life’s work, we didn’t ask for the burden we now bear.
We did not ask to be responsible for rescuing health care.But, here we are, and, as intimidating as the fact may be,
that burden is ours.
Donald Berwick, MD
We’re Here to Make Lives Better