2
OPMGUPDATE
Plenty to be proud of, Laboratory re-accreditation Ohio member and a patient of Dr.
but we must press on KP Ohio’s laboratories at the
Adams, that Leigh was diagnosed
continued from page 2 with stage III colon cancer. The
Chapel Hill, Cleveland Heights,
of diagnosis refresh “opportunities”) Parma, and Willoughby medical Mystery Diagnosis episode tells
daily to aid the effort. With the centers earned accreditation from Leigh’s story and recounts how Drs.
diagnosis refresh, we have two the Intersocietal Commission Adams and Scott helped save his
key goals: refresh diagnoses that for the Accreditation of Vascular life. The episode is still airing.
are still relevant and resolve “old” Laboratories through January 2010.
diagnoses that are no longer
Sustaining the
By participating in the accreditation momentum
pertinent. (Note: In Medicare’s eyes, process, the facilities demonstrate
credit is only given for a diagnosis a commitment to the performance This impressive sampling
refresh when it results from a of quality vascular testing and strive underscores in part the Herculean
face-to-face visit.) To help make to meet nationally recognized effort under way to prepare us
diagnosis refresh a proactive rather standards. During the accreditation for the critical challenges ahead.
than passive pursuit, an outreach process, vascular laboratories must The efforts also underscore the
pilot was established to identify and submit documentation on every momentum we have developed in
contact KP Ohio Medicare members aspect of their daily operations. just a short period of time.
due for diagnosis refreshes, office I, and all of my colleagues on the
visits, or both. Thus far, the outreach
KP HealthConnect Online
OPMG board of directors, extend
pilot, which focuses on KP Medicare If we want members to actively
a genuine thanks to all of you for
members with a comparatively participate in their care, then
persevering, for pressing forward
high chronic disease load, has we need to give them access to
with the effort to transform OMPG’s
helped boost diagnosis refresh information that can help make that
care delivery capacity and capability
performance. Overall, we have happen. And that’s exactly what
from “good to great” for 2008 and
made commendable progress in we did with KP HealthConnect
Online, the component of our beyond. In short, 2008 will be a
boosting our refresh numbers, but, defining “moment,” because how
new electronic medical record
given the higher disease burden well we fare in 2008 will largely
that gives member’s access to key
among our Medicare members, inform our existence and outlook for
health information. In addition to
we still have plenty of room for the years that follow.
reviewing lab results, immunization
improvement.
history, office visit history, and The test now is to sustain the
CME accreditation office visit summaries, members momentum so that we achieve
can view, request or cancel our objective of providing optimal,
In 2007, KP Ohio earned
appointments, request updates to coordinated care for our members.
provisional accreditation to present
the medical record and email any That means parlaying the strengths
continuing medical education
OPMG provider they have had of our integrated model, but more
(CME) programs. In addition
face-to-face contact with or with important, continuing to pursue
to making it more convenient
whom they have had a telephone market leading excellence in
for OPMG physicians to meet
encounters within the last three
mandatory CME requirements, quality, service and affordability,
years. This empowering tool will
an internal CME program helps for that is how we distinguish
aid our quest to optimize disease
showcase our multispecialty ourselves as a medical group and
prevention and management.
clinical expertise in the northeast in the marketplace. For all of us
Ohio medical community. And KPO physicians help within OPMG, the quality of our
because our clinical care is driven solve medical mystery professional life and career security
by evidence-based medicine, This spring, OPMG physicians we seek is directly proportional to
CME programs can be used to Ronald Adams, MD and Lawrence our commitment to excellence—
strengthen our delivery efforts. Scott, MD appeared in an episode excellence in preserving health,
The accreditation effort also of Mystery Diagnosis, a program managing disease, communicating
accommodates our ongoing need produced by Discovery Health. Ed with our patients, achieving effective
as practitioners to acquire new Leigh’s cancer symptoms surfaced stewardship and inspiring each other
clinical knowledge and continually in 1997, but it wasn’t until August to be the best we can be for our
hone clinical skills. 1999, after having become a KP patients, each other and ourselves.
3
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4
OPMGUPDATE
Advanced care management for care data reporting tools will allow us The other point to keep in mind is
delivery transformation to identify and resolve care gaps, that success of the ACM program
continued from page 4 improve panel management, depends on effective execution of
and efforts to the needs of their and optimize use of office visit all the program components and
patient panel. time. Putting data to work for their respective elements. Each
us proactively will enable clinical part of the effort supports another.
For the past several months, teams to improve overall member And though clearly a key to our
KP Ohio’s Bedford facility has care, optimize care for members sustainability mission, preservation
been piloting a project called with chronic disease, minimize the of cost-of-care dollars is just one
21st Century Collaborative Care, likelihood of undertreatment and of several payoffs the ACM effort
a key component of the APM. aid the coding, documentation and will yield. It also will allow us to
The 21st Century Collaborative diagnosis refresh efforts. practice better medicine and
exemplifies the potential KP has improve the health statuses of our
to use unconventional approaches Ambitious effort patients. Quality of care will be
to improve disease management. enhanced. We will become experts
This is a highly proactive approach To be sure, this is an ambitious
effort with an equally ambitious at managing chronic disease
to managing chronic disease and and comorbidity proactively. The
preventing events precipitated by timeline. Advanced care
management has to be up and member experience will improve.
or associated with them. Members
running with wrinkles resolved Member trust in us will build. Our
at high risk for chronic disease
in time to accommodate the expertise will attract the attention
and members diagnosed with
transition we’ll undergo regarding of employers grappling with
chronic disease are targeted for
reimbursement for our Medicare health plan costs and interested in
proactive, vigilant care. They are
literally mustered into the KP Ohio members. Under the new plan, proactive rather than reactive health
system to ensure they receive we become the primary payer for care. All of that means securing our
optimal, timely care and that they 100 percent of the care we deliver future in the region.
get guidance about managing to KP Ohio members eligible for Success of the ACM program also
their condition. Another feature of Medicare. The program, Medicare depends on support and embrace
advanced practice management Advantage, will be funded of it by everyone in OPMG and
is the advanced care panel. (See prospectively by the Center for
pages 6-8 for more details on 21st the health plan. To be sure, there
Medicare & Medicaid Services will be wrinkles and recalibrations,
Century care and the advanced care based on member data we provide.
panel.) but the overall plan is sound,
If that data is incomplete or and the early indications are that
inaccurate, the costs for treating the program offers tremendous
4) Infrastructure our Medicare members will exceed potential for us to take our care
The infrastructure component what CMS has allotted us for that delivery to a new level and make it
refers to the resources, tools, care. Essentially, we will be giving one that others will emulate.
and processes that will support away care for which we are entitled
implementation and maintenance to reimbursement. That’s why The ACM program sponsors
of member engagement, care accurate coding and documentation include Ruth Langstraat, MD,
management support and and annual diagnosis refreshes are vice president, health systems
advanced practice management. imperative; without them, CMS design and performance, Kaiser
These efforts depend on our gets an inaccurate reading on the Foundation health plan (KFHP);
access to accurate and timely
true health status of our members. Belva Denmark Tibbs, vice
data as well as our ability to fine
(Inaccurate member data also president, medical operations,
tune or overhaul structures and
constitutes Medicare fraud.) On KFHP; and Walid Sidani, MD,
workflows when necessary. Data
the other hand, the combination of vice president and associate
capture and reporting tools include
KP HealthConnect and POINT highly accurate member data and medical director, medical affairs,
(Permanente Online Interactive proactive disease management that OPMG. All of them deeply
Network Tools). POINT already results in more effective prevention believe in this endeavor and have
is helping us identify and more and control of chronic disease and worked tirelessly to help lay the
effectively manage members with of adverse events associated with groundwork for it.
chronic disease. POINT and other them, greatly improves our ability
to preserve cost-of-care dollars. continued on page 20
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6
OPMGUPDATE
21st Century Care Collaborative aids with or are assigned to a primary in turn “creates capacity” in the
effort to improve member health care physician. work days; that capacity, and the
continued from page 6 ability to create it, is one of the
3) Use alternatives to the keys to care teams gaining more
of who is in the panel and then control over, and deriving more
building relationships with those traditional office visit
satisfaction from, work life. Fishing
members using an array of Offering alternatives to the one- is integral to the 21st Century
strategies. In relationship based on-one, or face-to-face office effort and is explained in more
care, the care team really knows visit accomplishes several goals detail in the sidebar below.
its members; the electronic simultaneously: it gives members
medical record is used not just to and care team staff options for Alternative visits include telephone
communicating; it allows the care calls and emails between physicians
document and store nuts and bolts
team to have member “touches” and members; group visits and other
health information, but also to options are under consideration.
where none existed; and where
record information that improves
appropriate, an alternative visit
the task of providing individualized 4) Achieve total panel ownership
can replace the office visit. This
care. The medical record can relieves the member of the The essence of total panel
then be reviewed in advance attendant burdens and stresses ownership is providing the best
of appointments to improve associated with an office visit. possible care to the highest
the office- or telephone-visit Offering alternatives to the percentage patients in a given
experience and make them more traditional office visit also allows panel—in short, optimal panel and
productive. Another objective of the care team to achieve more population care management. The
relationship based care is ensuring control over panel management
that members have signed up using a tactic called “fishing.” This continued on page 9
7
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8
OPMGUPDATE
21st Century Care Collaborative aids filtering criteria. One example of a aid the disease management effort.
effort to improve member health total panel ownership effort is the In fact, the goal is to empower
continued from page 7 diabetes complete care program, members to become their own
which involves using POINT to primary care providers and to
goals include earlier intervention in identify members whose medical
or prevention of disease, greater use Kaiser Permanente’s delivery
status warrants commencement of
oversight and stepped up care of system to supply the expertise
the aspirin, lovastatin, lisinopril, or
members at high risk of medical ALL, regimen. and resources to help make that
events associated with chronic happen. Rather than being passive
disease, and proactive outreach to 5) Collaborative care planning participants, members are engaged
members who are not connected in management of their health care
This objective recognizes that
with, or have been out of touch and collaborate with the care team.
1) the medical office can be a launch
with, their primary care physicians They are cognizant of their care
pad for disease management,
and care teams. These tasks will be goals and take the necessary steps
but sustaining the effort means
aided by information technology tapping an array of tools to help to help ensure a healthy future.
resources like POINT, the panel keep members and care teams
management tool that makes it connected and communicating
If you have questions about the 21st
easy to stratify panel members Century Care Collaborative, contact Kris
and 2) collaborating with members Pilarski, project manager, at 98-330-4483 or
according to one, several or many about their care can significantly 216-635-4483.
Advanced care panel: improving welcome letter has been sent status of patients, to fine tune
management of chronic disease to a patient about joining the care plans and to troubleshoot.
continued from page 8 ACP; in the second case, the
message informs the physician Batches of 10 letters have
the member’s home and is of the patient’s decision to join been sent out weekly since the
performed by a physician, RN, middle of September 2007 and
or not join the new panel.
or both, depending on the this will continue until the team
patient’s health status. The The ACP physician, in turn, contacts the 150 members
house call makes moot the becomes the member’s new identified by POINT. If
full time primary care doctor. achieving the target enrollment
issue of transportation, which
of 150 proves elusive because
can be a significant barrier If patients have a change of
of member disinterest, the
to care, particularly among heart, they are free to return
inclusion criteria may be
older persons. In the wake of to their original primary care
broadened.
the house call, which is the physicians. Otherwise, it is
equivalent of a first office visit, expected that member’s The physician, RN, and social
the ACP team convenes to map will stay on the ACM panel worker are outfitted with
out a care plan for the member. indefinitely. The panel also will laptops that have wireless
collaborate with behavioral capabilities; they also get
Communication also occurs health, in the event their Blackerrys (a brand of personal
between the ACP physician expertise is warranted. digital assistant). Both
and the primary care physicians tools will have access to KP
of members being recruited Nuts and bolts HealthConnect. Clinicians also
to the panel: once at the time carry blood pressure kits and
For the time being, the otoscopes for house calls.
a welcome letter is sent to a
ACM team will be based at
patient and again if the patient
Willoughby. Team members Documentation is a key part
agrees to join the new panel. In
include Bill Schwab, MD; Willa of the effort, so there’s close
both cases, the ACP physician
Pugh, RN; Kathleen Skerl, collaboration with information
uses KP HealthConnect technology to ensure that
MSW; and Jill Arnold, PharmD.
messaging. In the first case, all of the care efforts can be
the message notifies the The team will meet on a regular captured accurately through
primary care physician that a basis to discuss the health KP HealthConnect.
9
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10
OPMGUPDATE
11
WINTER 2008
Ball is rolling for physician work life The answer lay in two of the People “Two-thirds of our physicians feel
committee Pulse indexes. The committee we don’t listen to their ideas,”
continued from page 11 concluded that by focusing efforts says Dr. Obi. “When you feel no
on addressing these two issues, one is listening, you stop offering
Once up and running, preliminary suggestions, possibly even stop
they would in turn be addressing
querying of OPMG staff by the caring about the organization. So it
multiple work life areas ripe for
Work Life Committee revealed is crucial that we address this.”
improvement. The two indexes are:
a spectrum of concerns—work-
day duration, clinical efforts “One of the challenges for
1) When clinicians have good
going unrecognized, opinions not OPMG leadership is that we do
ideas about improving the quality not always communicate in a
counting, too little control over of care delivered to members,
support staff hiring. Dr. Obi and his consistent and empowering way,
management usually makes use of and that hurts us,” says Dr. Wills.
Work Life colleagues decided that
them. “When we don’t do a good job
rather than trying to address many
providing context and rationale for
discrete issues individually, some of 2) I would recommend KP to a a business decision or explaining
which are uncontrollable and would close friend as a good place to get how we arrived there, when a
be encountered no matter where health care. decision may seem to arise out
or for whom a physician practiced, of the blue, that objective can
the committee would take a more Results from People Pulse 2006 come off looking disconnected or
strategic approach. showed that just 60 percent of unrealistic.” Moreover, problems
OPMG docs would recommend can also arise when messages get
“We wanted the greatest impact
KP to a close friend. A separate delivered to the “front lines” by
possible on work life improvement,
internal survey, commissioned by chiefs and leads as edicts. “There’s
and we concluded that would an opportunity there to have
Charles DeShazer, MD, associate
occur by taking a broader view an informed discussion, to say,
medical director, quality, showed
of the situation,” says Dr. Obi. ‘here’s the challenge, and I need
that just 54 percent would
“The question was, ‘what can we input from everyone as to how we
recommend KP. The 2006 People
do systematically to bring about might address the challenge, and
changes that resolve or address Pulse findings represent a drop of
if there are barriers, we need to
many of the issues raised? How do 3 points from 2005. As for ideas for
communicate those to leadership.’”
we have the greatest impact in the improving quality of care, just 24 Those conversations, says Dr.
shortest amount of time and make percent of OPMG docs feel their
work life better for everyone?’” ideas are used. That is also down
from 30 percent in 2005. continued on page 13
12
OPMGUPDATE
Ball is rolling for physician work life initiatives designed to respond to more proactive medical practice so
committee ideas offered to improve quality that they can better serve members
continued from page 12 of care delivery, see table 1. In and better manage their patients
addition to addressing People with chronic disease.” That also
Wills, need to be the rule rather
Pulse indexes, the Work Life
than exception when chiefs and supports OPMG’s and KP’s mission
Committee has also assembled
leads address their staffs. “That to improve performance on NCQA
empowers people and gives them ideas for improving physician
performance; see table 2.) metrics like CAHPS and HEDIS.1
a greater sense of ownership and
stake in the enterprise” Initiatives like the 21st Care
1 In pursuing its mission to measure and
improve health care quality, the National
Collaborative will be key to helping
With regard to addressing the Committee for Quality Assurance, or
care teams develop a better
low score on the “recommending NCQA, uses two tools: the Healthcare
sense of ownership and control Effectiveness Data and Information Set
KP to a close friend” index, some
over the work day, says Dr. Wills. (HEDIS) is used to monitor the quality of
efforts already are underway. “The 21st century model allows care in health plans; Consumer Assessment
These include a service initiative the physicians and care teams to of Healthcare Providers and Systems
launched in June 2007 at Cleveland organize their expertise as they (CAHPS) surveys are used to accurately
Heights and the piloting in spring see fit and distribute work loads and reliably capture information from
2007 of the 21st Century Care creatively across team members. consumers about their experiences with
Collaborative. (For examples of It allows the team to run a much care in health and Medicaid plans.
Table 1
Work Life Committee initiatives, • Allow practitioners to finance purchase of
recommendations tools or resources that can aide clinical duties
with study leave funds. For instance, speech
The Work Life Committee’s mission is to help recognition software, which would be used
identify areas of work life that are not optimally inside KP HealthConnect, could aid physicians
balanced and report on those to the OPMG Board. with limited typing skills. (In fact, the request for
The committee has an array of recommendations speech recognition software was approved at the
and initiatives on the drawing board or in the works. October 2007 board meeting.)
Shown here are examples of ideas generated to
help improve quality of care delivered to members. • Broaden the selection of training and educational
programs that are “practitioner friendly” (e.g.,
programs that are Web-based, CME accredited,
doable on study leave time).
Table 2
Work Life Committee: Ideas for improving • Increase opportunities for health care team
physician performance and cultivating members to build relationships with one another
ownership outside the workplace, for instance by creating a
sports league.
• Broaden the scope of productivity metrics to
include non-office visit encounters; for instance • Address staffing and coverage issues in the
include telephone contact and e-mails. Also, hospitals with which KP holds contracts. For
focus on outcomes rather than the number of instance, use a ratio formula to arrive at a staffing
patients seen in a given time frame. level that more appropriately aligns with the
number of hospital contracts, so that work loads
• Make more aggressive use of clinical coaching and travel time allow for optimal care.
to help physicians and support staff identify
opportunities to increase efficiencies,
productivity.
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14
OPMGUPDATE
Abramson’s anecdotes
What makes a good doctor?
Scott Abramson, MD Well, mea culpa. I’m guilty of must be this, that, or another
Clinician patient communication doing exactly the opposite of disease. Sure, they want these
consultant what these individuals say they issues addressed. But what
want from a physician. I can’t most patients want initially is
If we were to ask ourselves begin to count all the times 1) to feel safe (in other words,
that great clinical question— I have walked into an exam they trust us) and 2) to be
what makes a “good” room, chart in hand, serious reassured.
doctor?—I bet that some of look on my face, ready to get
our answers would include down to business. On the If you think about it, that’s not
words like “knowledgeable,” other hand, we are physicians. a lot to ask, particularly given
“conscientious,” “hard- We’re driven, focused, task that the office visit is a very
working,” and “compassionate.” oriented. We don’t much like personal interaction and one
But what if we posed the same anything—distraction, diversion, during which many patients feel
question to our patients? What pleasantries—that get in the vulnerable or exposed.
are the qualities that they way of office visit momentum.
Surely our patients understand So, when we walk into that
believe make a “good” doctor?
these basic facts of our clinical exam room, before anything
Recently, I attended a lives. Surely they comprehend else, perhaps we need to
community focus group meeting the incredible pressures welcome our patients first with
and had the extraordinary physicians and their staffs face a genuine smile and even a few
opportunity to hear lay people on not just a daily basis, but kind words or some gesture that
weigh in about what makes an hourly basis. Surely they relays a message of hospitality.
a good doctor and other understand that we’re in their Because with those actions, we
important clinical questions. corner, that despite our matter- are saying to patients, “You
This particular group was of-fact, down-to-business are welcome here. You are safe
made up of Indians who demeanors, foremost on our here. We’ll do our best to sort
had immigrated from that agenda is providing the care out what’s bothering you.”
subcontinent. they seek. Right?
Our reputation as a “good”
All agreed that the most Well, not to downplay the doctor may depend on it.
important factor in choosing a diagnostic expertise nor the
health plan was ensuring that (This column first appeared in April
desire to always move forward,
they would have access to a 2007 in CPC Consultant’s Corner,
but perhaps we need to think
“good” doctor. When asked a publication of The Permanente
about the answers that came
to elaborate on what makes a out of this humble focus group.
Federation Clinician/Patient
doctor good, here is what some Communication effort, online at
of them said: Perhaps before walking into http://kpnet.kp.org/cpc.)
that exam room, we need to
“When you first see him, he Dr. Abramson is a neurologist at the
pause just for a second or two,
smiles.” Hayward Medical Center in Northern
and remind ourselves what
California and is celebrating his 27th
“As he walks into the room, he brings patients to us in the first year with The Permanente Medical
makes you feel good.” place. I’m not talking about Group. He has spent all of his 27 years
the obvious forces that bring of service at the Hayward Medical
“Hospitality,” was another of them to our offices—the aches, Center, where he continues to learn
the descriptors used that night pains, or coughs, or the myriad about the art of communication from
by the focus group. symptoms that they believe patients and colleagues.
15
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16
OPMGUPDATE
Encryption effort protects health is inadvertently saved to a hard digital assistants, or PDAs,
information drive, encryption minimizes the such as Blackberrys and Palms.
continued from page 16 risk of it getting into the wrong Details of this effort are still
hands should the workstation being finalized by the IT and
drive of a workstation. “That be lost or stolen.” Users can
information should always be verify that a device has been compliance offices.
stored or saved within KP’s encrypted by locating the 1 From “Health Insurance Portability
computing network and data “Pointsec for PC” icon that
centers, on KP network servers, and Accountability Act of 1996”; public
displays on the Windows tool law 104-191, Aug. 21, 1996; via the
shared drives, or servers that bar (or task bar). It’s a “P” that
otherwise meet KP-IT security United States Department of Health and
slants to the left, set against a Human Services Web site, http://aspe.
standards,” says Barbara J. circular, green background. hhs.gov/admnsimp/pl104191.htm#1177.
Martin, privacy/security officer,
KP Ohio Regional Compliance, A related initiative involves For more information about the Secure
Privacy and Security Office. protecting health information Electronic Storage (SES) Program, go to
“However, if such information that gets stored on personal http://kpnet.kp.org:81/security/ses/.
17
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18
OPMGUPDATE
19
WINTER 2008
Advanced care management for care technology to help improve the DeShazer also co-led KP Atlanta’s
way KP delivers care and manages primary care redesign project, one of
delivery transformation its operations. At the Southeast
continued from page 5 the first models in the country that
Permanente Medical Group in Atlanta,
emphasized team-based primary care.
GA, where he was director of clinical
We look forward to working with you information systems, Dr. DeShazer In 1997, he became vice president
on this very important endeavor. developed an automated medical and national director of the KP mid-
record abstract application that Atlantic business processes and
produced one-page summaries of computing division, directing the
During his 16 patient records. The effort, used to installation of a $42 million claims
years with Kaiser expedite more than 500,000 annual processing system that yielded a
Permanente, Dr, patient visits over a 10-year period,
DeShazer has helped improve provider and member 40% reduction in per claim costs.
focused much satisfaction scores, lowered the He also co-led care management
of his energy on cost of medical record maintenance and community provider integration
using information and lowered malpractice costs. Dr. improvement initiatives.
Suite 1200
1001 Lakeside Ave
Cleveland, Ohio 44114-1153