Kaiser Permanente Transforming Care through Prevention

1. Kaiser PermanenteTransforming Care through Prevention Michael H. Kanter, MD, Medical Director of Quality and Clinical Analysis Southern California Permanente Medical Group Walter Allen, Executive Director, OPEIU, Local 30, Chair. Southern California Coalition of KP Unions Patti Harvey RN, MPH, CPHQ, Vice President Quality &Patient Care Services, Kaiser Foundation Health Plan/Hospital Michael H. Kanter, MD, Medical Director of Clinical Quality and Analysis Rick Rosoff, Medical Group Administrator, Baldwin Park Medical Center

2. Kaiser Permanente Southern California • 3.28 Million Members • 13 Hospitals • More than 120 Medical Office Buildings • 55,000 Employees • 6,500 Physicians • 280,000 Hospital Discharges • 34,400 Babies Delivered Annually • 17.7 Million Outpatient Visits • 22.7 Million Prescriptions Filled • 305,800 Annual Home Health Visits • $14 Billion Annual Revenue • Full implementation of electronic medical record in all hospitals and medical office buildings

3. Our Differentiation: Integration

4. Focus on one thing which sets us apart What we can be the best at:Prevention

5. Care Delivery TransformationClinical Stratetic Goals Benefits Achieved 2004 – 2009

6. Osteoporosis Management2009 Vohs Award Winner

7. SCR Healthy Bones Model of CareIs it working? YES!!!!! Hip fracture rate 41% lower then expected 2008 - Saved 1,000+ hip fractures and 250 lives* DXA rate for Patients 60+ with FX = 79% RX rate for patients with bad DXAs = 73% DXA Screening Rate for Men & Women = 82% Osteoporosis Medication Adherence = 63+% * Source: R. Dell, MD, 2008 data

10. Congestive Heart Failure (CHF) National 90th percentile 29 point Increase in 2 Years ^ ^

11. Baseline Data Trend for Exercise in SCAL May 2009 Sept 2009 May 2009 Sept 2009

12. Smoking Cessation Regional Trend

13. Kaiser Permanente Care Management Southern California California Cooperative Health Care Reporting Initiative (CCHRI) 2008 Number One Rankings Among Health Plans Available in Southern California KP recognition for quality excellence * Number one ranking totals include ties. The Clinical Quality Measures cover pre- and postpartum care, childhood and adolescent immunizations, women’s health, preventive health screenings, chronic disease management for asthma and diabetes, mental health care, cardiovascular health and appropriate utilization measures. Source: 2008 CCHRI Health Plan Report Card.

14. Enhancing our Brand Image: Office of Patient Advocate Data

15. Complete Care More centralized coordination with implementation support Proactive Encounter Regional Outreach Population Care Information & Decision Support Self-Management & Health Education Populations’ Management Complete Care Infrastructure Pharmacy Operations Proactive Panel Management Care/Case Management *All based on evidence-based clinical practice guidelines

16. New Member Entry Program PanelManagement Case Management Call Centers Portal Flu Shot, etc. New Member Mailer Corona Smoking, Exercise, Weight Mgmt., Nutrition Health Education Programs Incentive Program Health Risk Assessment Healthy Living Helpline CSGs kp.org, KP Health Connect™ Member Outreach Preventive Care Proactive OfficeEncounter Lives Saved Missed Opportunity Report

17. Proactive Office Encounter (POE) Pre Visit Visit Post Visit • Office Encounter Management • Pre-encounter follow-up • Vital sign, history, social, demographics, medication review • Identify and flag alerts for provider for screening and uncontrolled chronic conditions • Room and prepare patient for necessary exams • Proactive Identification • Identify missing labs (A1c, LDL, microalbumin), screening procedures, access management, KP.org status, etc. • Provide member instructions prior to visit • Contact member and document encounter in HealthConnectTM • Immediate: • After visit summary, after care instructions, follow-up appointments, health ed materials, how to access info on KP.org • Future: • Follow up contact & appointments per provider Messaging Support • Phone calls • E-mails • Letters

18. Proactive Office Encounter • Leverages the info in KP HealthConnect • Healthcare team uses KP HealthConnect and POINT (registry) to identify member-specific care gaps • Provides alerts if patient is missing important tests • Works in Primary and Specialty Care offices • Info is available prior to, during appts, and through outreach

19. Kaiser Permanente’s Registry for Chronic Diseases and Panel Management Provides Insight Across Disease Spectrums • Eight Major Clinical Registries: • Asthma • Heart Failure • Diabetes • Coronary Artery Disease • Chronic Kidney Disease • Cardiovascular • Hypertension • Panel Management

20. Physician Leadership • Developed Chiefs of Service goals • Structured meetings based on KP Promise • Lead proactively – drive performance • Role model • Administer Year-end evaluations • Each Chiefs Group should develop goals where we can lead the country

22. Characteristics of Unit Based Teams (UBT) • Performance improvement focus using consensus based decision making skills • Sufficiently trained on their unit with minimal interruption to daily operations • Performance of the unit based team is measured against established organizational metrics • Co-led by management/physician and front line staff Source: KPSC Regional UBT Guidelines

23. Kaiser Permanente Southern California Labor Management Partnership Employees Engaged in UBTs March 30, 2010

24. Unit Based Team Work Within Scope Issues & work processes at department or unit level Localpolicies, systems, assignment, schedules, workflow, etc. Attainment of regional and local performance goals Working within parameters such as contract, budget, regulations, law, regulatory requirements, etc. Out of Bounds Issues related to larger entity than your unit Union contractual issues Individual performance or behavioral issues Creating agreements which are not in compliance with regulatory or legal requirements.

25. UBT Performance Improvement Work Aligned with Kaiser PermanenteRegional and National Strategic Goals Southern California Performance Sharing Plan Goals • Attendance • Clinical Goals • Controlling High Blood Pressure • Successfully Captured Opportunities Rate • Blood Sugar Control Testing • Cervical Cancer Screening • Lipid Control Testing • Healthy Workforce • Inpatient Care Experience (H-CAHPS survey – Overall rating of hospital) • Outpatient Care Experience • Helpful/Courteous Receptionist • Helpful/Courteous Nurse/Assistant • Workplace Safety