Sharon Levine, Associate Executive Medical Director of the Permanente Medical Group, outlines how the Kaiser Permanente integrated care system operates and describes the role of multispeciality medical practice in promoting integration.
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A 60 Year Journey, With No End in Sight
Sharon Levine, M.D.Associate Executive DirectorThe Permanente Medical Group
Social purpose Quality-driven Shared accountability for
program success Integration along multiple
dimensions Prevention and care
management focus
Kaiser Foundation Hospitals
PermanenteMedicalGroups
KaiserFoundationHealth Plan
Health PlanMembers
Kaiser Permanente: an integrated model of health care financing and delivery, a unique relationship among three separate entities – partnership, contract, and exclusive
Integration in care delivery: Primary care, specialty care – equal partners; ancillary
providers, and ancillary diagnostic and therapeutic services co-located, part of care teams
“Continuum of care” – home, provider office, hospital, nursing home/SNF; role of telehealth
Continuum of an illness – primary and secondary prevention, diagnosis, treatment, chronic care management and follow-up, supportive care, and palliative care – from “potential” to “real”
Integration “over time” – long time horizon, investment mindset
Physician responsibility for quality and cost of care – somewhat unique in US healthcare until very recently
Peer accountability: common medical record and “examined practice” for quality and efficiency in care delivery – even before we had an EMR
Shared and individual accountability – stewardship for member resources and for the health of populations collectively, in addition to duty to individual patients
Broad engagement in “shared accountability” efforts enables “individual autonomy” in the examination room and at the bedside.
Salaried physicians, with strong (personal) incentives re quality, neutral re volume/quantity of services provided
Accountability exercised through self-managed and self-governed medical groups
Responsibility for clinical care and patient satisfaction, quality improvement, resource management, design and operations of care delivery system
Physician leaders emerge from clinical ranks, then trained in business knowledge, leadership, and management skills: professionals leading professionals
Broad, distributed model for leadership –
Intentional effort to recruit for leadership – “every physician a leader”
Substantial investment in customized management training and leadership development
Leader’s role – build and maintain a culture of pride, performance and accountability
Ultimately, structure and governance are important as “facilitators”; but only if they deliver value, and facilitate continued performance improvement
This requires… effective and committed leadership aligned incentives culture of performance and accountability
It’s about results…
“The American health care system is more expensive than any other, without providing better results. The cure (says Brent James) is measurement.” (New York Times Magazine, 11/08/09)
Translating evidence into benefit: Cardiovascular disease
Evidence Benefits
Abundant body of evidence A 13 point reduction in blood pressure can lower
deaths due to CVD by 25% 4 generic medications can reduce CV event risk by 50%. 7 interventions in the ED/Hospital can reduce mortality Managing transition of HF patients from hospital to home
can reduce readmissions and prevent catastrophic declines