Kaiser Permanente leaders discuss the foundations of delivering accountable care

Samantha-Dupont
Samantha-Dupont
Samantha DuPont, MPH, Health Policy Consultant

Efforts to develop Accountable Care Organizations (ACOs) have been gaining steam in the past year, following provisions in the Affordable Care Act that established the Medicare Shared Savings and Pioneer ACO programs.

Because ACOs are a relatively new concept in care delivery, questions remain as to how successful they will be in improving health outcomes and reducing health care costs. A panel of Kaiser Permanente leaders gathered earlier this summer to discuss how lessons from our integrated delivery system can be used to inform the implementation of ACOs.

On May 30th, HealthLeaders Media hosted a webcast entitled “Building ACO Foundations: Lessons From Kaiser Permanente’s Integrated Delivery Model” featuring George Halvorson, CEO of Kaiser Foundation Health Plan and Hospitals; Murray Ross, Vice President of Kaiser Foundation Health Plan and Director of the Kaiser Permanente Institute for Health Policy; Dr. Robert Pearl, Executive Director of The Permanente Medical Group; Dr. Benjamin Chu, Group President of Kaiser Permanente’s Southern California and Hawaii regions; and Dr. Amy Compton-Phillips, Associate Executive Director of Quality for The Permanente Federation. The panelists highlighted three foundations of the Kaiser Permanente system that are essential for delivering quality care: care teams, an emphasis on the total health needs of the patient, and implementation of an electronic health record (EHR).

Teams are at the heart of Kaiser Permanente’s care delivery model. These teams comprise clinicians and other care providers who communicate with one another and coordinate patient care. The primary care site—a multi-disciplinary office complex—serves as the central “hub” for care coordination. Primary and specialty care physicians, nurses, pharmacists, therapists, and others work together to achieve the best patient outcomes. Although it is a simple concept, care teams can be difficult to create, in part, because medicine has historically been practiced in silos. To combat this, a culture of shared accountability must be embedded within the delivery system. “It’s about accountability,” said Dr. Benjamin Chu. “If everybody really takes their share of accountability, and we can actually track it and follow it over time to see if we’ve met that accountability, then I think we’re all better off.”

Having care teams in place, however, is not enough to ensure that high quality care is delivered. Care teams must be proactive in treating the patient, which means focusing on preventive care and making sure gaps in care are addressed as they are identified. For example, everyone involved in the patient’s care is encouraged to identify care gaps and help patients get needed care, such as mammograms or colorectal screenings. As Dr. Compton-Phillips pointed out, the onus is on health care providers and staff to be proactive any time a patient visits the care site because many patients only see a doctor when they have an acute health problem: “If you [the patient] are healthy, you’re not going to go to the doctor. Every person you come into contact with, needs to get you to remind you to get tests and screenings.”

A key enabler to providing coordinated, quality care is a robust electronic health record. Kaiser Permanente’s EHR, HealthConnect, provides real-time health information to all providers, and includes clinical decision-making tools and systems for identifying gaps in care. Kaiser Permanente’s mobile applications, telemedicine capabilities, and online patient health record round out a portfolio of technologies that drive modern health care. “When you have 21st Century technology in an integrated system,” said Dr. Pearl, “what you change is the complete patient experience. Patients can get care sooner, [and] they can get the right care the first time. There are no delays, there are no misunderstandings, [and] there are no errors that get created.”

Together, these three foundations of care delivery have helped Kaiser Permanente achieve significant gains in health outcomes. In particular, the panelists highlighted improvements in HIV/AIDS and sepsis care that have hinged on these core principles. The Institute for Health Policy previously reported on these successes with HIV/AIDS and sepsis care. Kaiser Permanente patients with HIV/AIDS are cared for by multidisciplinary teams composed of physician specialists, care managers, pharmacists, social workers, mental health professionals, and nutritionists who collaborate to meet the full needs of our patients. Nearly 70 percent of our HIV-positive patients have maximal viral control, compared with 19 to 35 percent nationally. Our HIV mortality rate is 1.6 percent, compared with 3.4 percent nationally.

With regard to sepsis care, collaborative care teams and real-time EHR technology have enabled us to better identify the early stages of sepsis, which is crucial for reducing mortality. Since we implemented our sepsis program, we have seen a threefold increase in the rate of sepsis detection and a 60 percent reduction in mortality.

A key takeaway of the HealthLeaders Media webcast is that the lessons we have learned at Kaiser Permanente can be applied to other health care systems.  While many of our proudest achievements in care were facilitated by our large size, health care leaders should note that changes in our care practices often emerge from a single care site.  As CEO George Halvorson explains, “We didn’t invent new sepsis [care practices] spontaneously, simultaneously, everywhere. We didn’t one day come to work and discover there was a better way.  We had one site, where we had one really brilliant, insightful practitioner who said, ‘What if we did this.’  Because we have a culture of innovation, we tried it in that site, and it worked.”  Other health care systems can achieve similar gains by engendering a culture of innovation, where clinicians are empowered to develop creative solutions in the delivery of care.

The next HealthLeaders Media Rounds with Kaiser Permanente entitled “Health and Social Media will be held on October 16, 2012.  For more information, please visit this link.