Richard Dlott M.D. Medical Director of Population Care Kaiser Permanente - NCAL October 1, 2010

1. 3rd Annual Dean’s Right CareCardiovascular and DiabetesLeadership SummitTaking Action Together toPrevent Heart Attacks & StrokesReaching 90th percentile Targets: Medical Directors Report on Health Plan Strategies, Programs, Plans, and Achievements Richard Dlott M.D. Medical Director of Population Care Kaiser Permanente - NCAL October 1, 2010 

2. 2010 HEDIS Data – NCAL & SCAL Kaiser Permanente Total Enrollees: ~ 6M NCALSCAL • Heart Disease: ~ 300K ~ 350K • LDL-C ≤ 99: 75%* 73%* • Hypertension: ~ 600K ~ 650K • BP ≤139/89: 80%* 84%* • Diabetes: ~ 200K ~ 250K • BP ≤139/89: 80%* 83%* • LDL-C ≤ 99: 66%* 63%* • A1c ≤ 9%: 80% 76% *Above 90th percentile 2010 HEDIS

3. Key Strategies for Preventing Heart Attacks & Strokes “A L L” • Improve Use of PHASE Medications • ASA, Statins, ACE-I & Beta-blockers • Improve Risk Factor Control • LDL, BP & A1c • Promote PHASE Lifestyle • Tobacco Cessation, Physical Activity, Healthy Eating, & Weight

4. Key Strategies for Reaching Targets“4 Wheel Drive” of Performance Improvement • Leadership Alignment • Standardization / Systemization • Project Management • Data that Drives Destination Compelling Need to Move

5. Key Strategies for Reaching Targets:Aligned Leadership w/ Clear Roles • MD Champions • Serve as Clinical Expert, Mentor, & Liaisons to Dept of Medicine • Implementation Site Coordinators (ISCs) • Oversee Implementation of Tools and Strategies to Drive Performance • Program Managers • Assign & Manage Resources Required to Complete Implementation

6. Key Strategies for ImprovingMedication Adherence – Simple & Effective BP = Prinzide DM = NPH Insulin LDL = Simvastatin

7. Outreach Tools Letters Phone Reminders Email Reminders Inreach Tools Call Center Prompts EMR Alerts Care Management Interventions Key Strategies for Reaching Targets:Don’t Just Wait for the Member to Come to Us • Member Directed Care • Preventative Health Prompts: Reg Slip / Online • Classes • Online Information, Email Your Doctor

8. Disease Registries PHASE (DM, CAD, CVD, AAA) Hypertension Diabetes Population Management Tool Stratify Population by Care Gaps Develop Lists of Members with Care Gaps for Outreach Key Strategies for Reaching Targets:Data that Drive

9. Key Strategies for Reaching TargetsAnnual Performance Goals & Incentives Annual Goals Performance Tracked Monthly

10. Strategies for Reaching TargetsBlood Pressure Cuffs at Home • Home BP Monitoring • High Quality Machines Sold in Pharmacies • Home Monitoring Taught In Classes • MA BP Checks Include Validation • Self Reported Home BP’s Used for • Treatment Intensification

11. Age- and Sex-Adjusted Incidence Rates of Acute Myocardial Infarction, 1999 to 2008 ↓ 24% ↓ 62% NEJM 362;23 2010

12. Lessons Learned • Focus on Alignment First • Make a Compelling Case • Keep it Simple • Set Goals and Provide Tools • Don’t Wait for the Member to Come to You • It Takes a Team • Monitor Performance • Learn from the Best