iHT2 Health IT Summit in Phoenix 2013 – Terhilda Garrido, VP, HIT Tranformation & Analytics, Kaiser Permanente Case Study "Big Data, Little Data: Value and Transformation stemming
Case Study "Big Data, Little Data: Value and Transformation stemming from KP's HIT"
Learning Objectives:
∙ Learn about KP's investment in the EHR and its transformative value ∙ Learn how data and access to information has impacted clinical operations, the patient experience and how we approach research ∙ Learn how this data is more patient centric and patient empowering
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29 total top rankings – 13 Medicare & 16 commercial – the most No. 1 rankings for health plans in the country
563 applied for Star ratings11 plans across the country received 5 stars6 of those were Kaiser Permanente plans:California, Hawaii, Northwest, Colorado, Mid-Atlantic States, Ohio
17 Top Hospitals33 Hospitals among safest in the nation
Mail-order pharmacy programs rated at the highest level of customer satisfaction in the entire country four years in a row
Highest ranking in member satisfaction among health plans in all five of our larger regions
1. Health Care Knowledge Level: A tale of two studies
Tale of Study 1 – It was the best of times, it was the worst of times for researchers in the city of San Antonio…
ALLHAT* – a classic RCT – randomized control trial 42,418 patients $120 million Conducted over 8 years
Results – Thiazide-type diuretics are most effective at controlling hypertension
Given the low cost of this diuretic class, they postulated $3.1 billion savings over 10 years
ALLHAT* – Antihypertensive , lipid lowering treatment to prevent health attack trial. Sponsored by the national heart, lung and blood instituteBegley, Sharon, "The Best Medicine," Scientific American 305, no. 1 (2011):50-55
1. Health Care Knowledge Level: A tale of two studies
Tale of study 2 – Meanwhile in Denver, David Magid, MD had an idea….ALLHAT – a classic RCT – randomized control trial 42,418 patients $120 million Conducted over 8 years
Results – Thiazide-type diuretics are most effective at controlling hypertension
*Magid, David J.; Shetterly, Susan J.; Margolis, Karen L.; Tavel, Heather M.; O’Connor, Patrick J.; Selby, Joe V.; Ho, P. Michael, “Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors Versus β-Blockers as Second-Line Therapy for Hypertension”, Circ Cardiovasc Qual Outcomes, 2010;3:453-458.
Magid* study• 4,000,000 patients• $200,000• Conducted over 1.5 years
• Results – For the 60% of patients that were not under control / complete hypertension control, ACE Inhibitors and beta blockers are effective as 2nd line medications.
1. Health Care Knowledge Level:A tale of two studies
ALLHAT Study Magid Study
Statistical Design
Randomized Control Trial Retrospective observational
- Eliminate Patient Bias -Adjust for patient bias: Matched case control. N.b. needs a large sample
- Limited target group - Cross-sectional population
- Controlled conditions - Real World conditions
Results $120,000,000 over 8 yrs $200,000 over 1.5 yrs
42,418 patients 4 million patients
RCTs are the traditional gold standard for health care research. EHRs and their vast store of data (in depth and breadth) offer an alternative with pros and cons.
I try to learn as much as possible about diabetes. I have been controlling it with diet and exercise for 3 yrs. Dr. says I am doing a good job, thanks to your site.NCal 2010
I feel much more confident, and I also feel closer to my physician that I had before. I don’t feel intimidated anymore.
I feel more in control over my medical condition. I have access to information, access to people I need to consult with, so it puts me back in charge. KP NW Member, 2004 Online survey
I was curious what they had to say. I have a heart condition, and the words they use are so big that I wanted to go back and be able to actually look at what it was. It was a good thing for me to look at it and to get it to stick with me that I need to take better care of myself when I saw it in black and white.
I think it’s empowering. As individuals we need to take care of ourselves, and we have to assume responsibility and it gives us that.
The website has improved my relationship with my doctors. It’s so easy to communicate with them, and they are all willing to respond quickly. I am very impressed with this method and feel it has made taking care of myself easier and more palatable. I feel supported in this way because the computer is available 24/7.
It’s made it better because I feel there is a closer partnership. It’s like instead of not seeing him for six months, we have communicated in between.
I feel more in touch with the sum and substance of my medical condition.
5. Patient Engagement Rewards: Loyalty & Quality of Care
Member RetentionMy Health Manager users were 2.6 times more likely
to choose to remain members than were those who did not use it.1 Following membership tenure and illness burden, MHM use was the third strongest predictor of remaining a member. The newer the member; the stronger the impact of MHM.
Quality of Care Improved! In a matched-control analysis published in Health
Affairs, secure email was associated with a 2.0 to 6.5% improvement in performance on HEDIS measures, such as glycemic (HbA1c), cholesterol, and blood pressure screening and control2
High Patient Satisfaction!85% rated encounters 8 or 9 on a 1-9 scale3
1 Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne, “Association Between Personal Health Record Enrollment and Patient Loyalty,” Am J Manag Care. 2012;18(7):e248-e253 (web exclusive)2Zhou, Yi Yvonne; Kanter, Michael H; Wang, Jian J; Garrido, Terhilda, “Improved Quality at Kaiser Permanente Through E-Mail Between Physicians and Patients,” Health Affairs, Vol 29, No 7 (2010); 1370-1375.3 Internal KP study, “Harvesting Value: Early Findings from Kaiser Permanente HealthConnect™” presented to Center for Information Therapy by T Garrido, C Serrato, J Oldenburg (1/15/2008)