Sustainable Affordability Kaiser Permanente – A Private Health Care Solution for Millions of Americans Bernard J. Tyson Senior Vice President Kaiser Foundation Health Plan, Inc. Kaiser Foundation Hospitals Oakland, California – U. S. A.
U. S. Health Care Spending 2003 = $1. 7 Trillion 2013 Projected = $3. 4 Trillion ($ Billions) Projected Source: Center for Medicare & Medicaid Services Other: Research and Construction 2
Chronic Illness Drives Medical Care Costs $$$ People 6% Those with multiple chronic conditions 21% 72% Segments within the total population Those with one chronic condition Those with no chronic conditions 33% 31% 36% Costs associated with each segment Source: Kaiser Permanente Northern California commercial membership, Dx. CG methodology, 2001. 3
Cost Distribution of Care % of Health Care Costs 100% 80% 60% 40% 10% total cost Premium level 20% 0% total cost 0% 0% 20% of people 40% 60% 80% 100% % of People 70% of people Source: Milliman USA Health Cost Guidelines – 2001 Claim Probability Distribution 4
Typical U. S. Health Plan Spending 20% people account for 0% of total health care costs 70% people account for 10%of total costs 10% people account for 90% of total costs Source: Milliman USA Health Cost Guidelines – 2001 Claim Probability Distribution 5
The Health Care Dilemma: Managing Costs vs. Managing Care Managing Costs • Product Strategies • Shifting Costs
Are the Two Mutually Exclusive? Managing Care • Disease Management • Preventive Care • Coordinated Care 7
Kaiser Permanente’s Strategy for Sustainable Affordability Managing Care Managing Cost 8
Kaiser Permanente: America’s Largest Non. Profit Health Care Program § Integrated health care delivery system § Serve 8. 5 million members in nine states and D. C. § $30 billion annual revenues 9
Kaiser Permanente’s Mission To provide high quality, affordable health care services and to improve the health of our members and the communities we serve. 10
Kaiser Permanente Partnership A Prepaid Integrated Delivery System With Aligned Incentives Permanente Medical Group Health Plan Members Kaiser Foundation Hospitals Kaiser Foundation Health Plan 11
2004 National Quality and Service Recognition NCQA’s “The State of Health Care Quality: 2004 Report" America’s Health Insurance Plans 2004 KP Northern California Ellis J. Bonner Community Leadership Award – Child Health Plans KP Northwest National Exemplary Practice Award – Cardiovascular Risk Factor Management KP Colorado was ranked in the top 10 health plans in the United States for HEDIS Effectiveness of Care. Consumer Reports 2003 Ranking of 49 HMOs and 43 PPOs Disease Management Association of America 2004 KP’s Care Management Institute was honored for "Best Overall Disease Management Program for a Managed Care Organization. " KP Northwest was rated #1 in the United States. KPNW was tied for the top rating with Capital District Physician’s Health Plan in New York. Hospitals for a Healthy Environment 2003 -04 The Centers for Medicare and Medicaid Services (CMS) 2003 KP Northwest Top 10 Medicare + Choice plans: Award based on disenrollment rates, HEDIS, CAHPS, HOS results, and biennial audit results 2004: -6 Environmental Awards for comprehensive waste minimization and pollution prevention. -3 awards for virtual elimination of mercury -1 award for self-identification of environmental goal. 2003: 20 Environmental Awards for 18 KP California facilities American College of Medical Quality (ACMQ) 2004 KFHP Institutional Leadership in Quality Awards KFHP Historic Leadership in the Development of Innovative programs in Quality
2003 -04 State & Business Groups Health Plan Report Cards 2003: #1 for Quality measures: Kaiser Permanente received more “top 10 percent” ratings than all other health plans in California combined. California Office of Patient Advocate 2003 HMO Quality: KP Northern California • “Excellent” rating for Care for Getting Better Medical Group Quality: The Permanente Medical Group Southern California Permanente Medical Group • “Good” rating for Communication with Patients National Minority Health Month Awards 2003 Cultural Competence Award Colorado Business Group on Health 2003 Clinical Care Top scores (above NCQA benchmarks) on 8 of 15 measures for KP Colorado. No other Colorado health care plan achieved this level. Maryland Health Care Commission 2003 Quality KP Mid-Atlantic States rated a “Star Performer” in 10 of 23 measures. No other plan achieved this level. Service KP Mid-Atlantic States rated a “Star Performer” on customer service and few customer complaints. Pacific Business Group on Health 2004 KP Northern California Top rated HMO out of plans surveyed in 2003.
Third-Party Endorsements New York Times October 31, 2004 “Is Kaiser the Future of American Health Care? ” 14
Third-Party Endorsements The Economist July 15, 2004 “Without question Kaiser has achieved a greater degree of integration than the NHS— integration between prevention and cure, out-patient and in-patient services and between primarycare physicians and hospitals. ” Richard Feachem Executive Director Global Fund to Fight AIDS 15
10 Clinical Priority Areas KP Members Area with this Condition Self Care Chronic Pain Clinical 8. 4 MM ~1, 000 Elder Care 917, 000 Diabetes 577, 000 Depression 411, 000 Coronary Artery Disease 256, 000 Asthma 141, 000 Heart Failure 94, 000 Cancer 25, 000 new cases/yr Obesity ~25% of adults 16
Population Management: More than Care & Case Management Targeting Population(s) Redesigning Processes Measurement of Outcomes & Feedback Level 3 Intensive or Case Management Assisted Care or Care Management Usual Care with Support Highly complex members Level 2 High risk members Level 1 70 -80% of a CCM pop 17
Professional Satisfaction: Primary Care Physicians of KP Are Better Supported in Delivering Quality Percent of Physicians Reporting Factors as Care and Service Affecting Incentive Compensation Percent of Physicians Reporting That Pressure Compromises Care Source: Grumbach, et. al. , California Physicians 2002: Practice and Perception 18
KP Health. Connect : $4 Billion Investment to Bring 21 st Century Technology to Health Care Essential Tools to Improve Safety, Quality, Service and Efficiency PCPs Nurses Efficiency and Productiv ity Specialists Pharmacy Lab/X-ray Patients s Billing and Coding Data Managemen t Advice Line Health Encyclopedia Schedulin g Systems KP Health. Connect Safety and Quality Service and Satisfacti on Evidence Based Care 19
EMR – A Necessity for the Future 20
EMR – A Necessity for the Future “…The Americans also got the lowest marks for medical records being unavailable at the time of the patient's appointment…” Release of International Survey Findings Commonwealth Fund, Health Policy Symposium Washington, D. C. , Nov. 3, 2005 21
Feds Relax Rules on Use of E-Records October 6, 2005 President George W. Bush has made expanding the use of electronic medical records one of the top healthcare priorities for his administration. The systems are widely thought to have the potential to cut healthcare costs and reduce the estimated 44, 000 to 98, 000 deaths caused by medical errors each year in the United States. 22
Health. Connect Application Degree of comprehensive data and integration Integrated EMR Benefit Quality measurement, improvement & research Inpatient, Outpatient, Lab, Pharmacy. Clinical Decision Support Remote Access Medication Order Entry Internet Access Email Communications, Online Health Information, etc. Automated Reminders Improved diagnosis & disease management Increased physician timeliness & efficiency Reduce prescribing errors Improved patient access and convenience Improve compliance with practice guidelines (Preventative & Monitoring Tasks) Charting/Documentation Improve effectiveness through access to patient history 23
Kaiser Permanente’s Mission To provide high quality, affordable health care services and to improve the health of our members and the communities we serve. 24
Questions, Comments & Answers 25
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