Editor’s note: This post is part of a Health Affairs Blog symposium stemming from “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy. Links to all posts in the symposium will be added to Abbe Gluck’s introductory post as they appear, and you can access a full list of symposium pieces here or by clicking on the “Yale Health Care Industry Symposium” tag at the bottom of any symposium post.
Health care organizations are undergoing an expanding array of consolidations and cross entity acquisitions. Large health plans are planning mergers; hospital systems are consolidating with other hospitals and health systems; and physicians are organizing into larger groups — often with health systems, but occasionally with health plans and other care providers.
Retailers, particularly those with pharmacy operations, are providing primary care services. Online start-up firms, using new technologies, are entering the care delivery and care organizing space. Accountable Care Organizations are taking on payer and provider characteristics as rising numbers hope to use coordinated and integrated care models to improve health and save money. This intense activity has begun to blur the lines between traditional segments and roles in health care.
The great hope for this consolidation activity is that these cross-segment entities can help steer the transformation of care from a fragmented, fee-for-service based system to a delivery system focused on value-based care. Through coordination, integration, and quality services, the grand aspiration is the achievement of what has been labeled in health care the “Triple Aim” — improved population health, improved individual outcomes and experience, and greater efficiency.
The Kaiser Permanente Model
Kaiser Permanente has been held up as an “end-state” model that could result from the flurry of health care consolidation. Our 70-year old organization is the country’s oldest group health model offering health maintenance organization (HMO) plans. We currently serve 10.2 million members in eight states and the District of Columbia. A decade-long investment in digital information technology, population health tools, and system-level care delivery changes has resulted in an organization that now consistently achieves high levels of service and quality on virtually all metrics commonly used to rank health plans and health care organizations.
This level of performance does not happen magically. It is the result of an intentional and dedicated effort to achieve:
- Full alignment and integration of delivery and payment systems.
- Meaningful, real time, and actionable quality and performance information.
- Transparency of performance — especially for physicians, with internal and external benchmarks.
- Clear and unambiguous leadership direction.
- Willingness to leverage every aspect of the delivery system to help achieve top-level performance.
We are able to collect patient information from a variety of sources through our electronic health record and other systems to create data repositories. This allows us to apply algorithms, informed by evidence-based medicine, to:
- Stratify population health risks.
- Identify subgroups to supply needed specific complex care or to address health disparities.
- Help with development of patient management tools.
- Target panel lists.
- Provide prompts and reminders for clinicians.
- Produce letters and automated telephone outreach to members.
- Monitor and process improvement measures and reports.
- Target health education and self-care support.
- Create point-of-contact tools.
These tools help our system track gaps in needed care for individuals and allow our staff from multiple levels to address them. This approach has enabled Kaiser Permanente to respond to a variety of ambulatory and inpatient performance issues successfully.
Another tool we’ve developed involves a digital safety net designed to ensure that our patients with abnormalities, identified through a variety of testing, receive the proper follow-up for adequate diagnosis and treatment. In most ambulatory settings it is all too common to have patients “fall through the cracks” for a variety of reasons. In our system, algorithms that look for completed follow-up—for conditions such as high Prostate Specific Antigen levels, blood in the stool, solitary pulmonary nodules, abnormal cancer screenings, or high-risk medications—have prevented irreparable harm through the timely identification of patients falling, or about to fall, through the cracks.
Integrating Payment And Delivery
Integration of pre-payment with care delivery allows Kaiser Permanente to begin to take advantage of an increasing array of old and new tools to deliver care to our members without jeopardizing the economic model. Pre-payment puts an emphasis on preventive care. It also puts a priority on solving problems proactively. Remote access to medical records, imaging, and lab results allow our system to break down geographical and temporal barriers to getting care when needed. We can use telephone, video, email, and other channels to give our members access to our clinicians, nurses, and pharmacists on a virtual basis. Personal Action Plans and member access to their own health records—available online, along with a variety of self-care management tools—help our members actively participate in maintaining their health.
Non-traditional delivery channels, including telehealth and social media, now offer our members new and expanded access outside of our medical office and hospital walls. Teleconsultations, telestroke, teledermatology, and teleopthalmology services are some of the new approaches integrated into our care model. Access to physicians and nurses via phone and or video 24 hours a day, seven days a week will also expand services to our patients. Additionally, social media support sites are in development to assist with care for emotional health needs such as depression, anxiety, and other conditions.
Addressing Social Determinants
Another advantage to complete integration of the delivery system and the payment system comes from the ability to take the long-term view in serving members and communities. The average Kaiser Permanente member who stays with us past the first year remains a member for 15 years. If we take this longevity into account where the membership is a significant portion of the population, it allows us to think about investing in the communities where our members live and work in a more holistic way. Decentralizing our medical offices and using them as an anchor to leverage other agencies and organizations to create more vibrant communities becomes both feasible and desirable.
Integrating our health care approach with a strategy to address upstream social determinants of health, a “life integration strategy,” is a direct result of a longer term approach to health. Investments in addressing food adequacy, housing, jobs, education, and the physical environment can be weighed in the context of the long-term effects on the health and well-being of our members and the communities where they live. Helping to build parks and walking paths and encouraging grocery stores to enter communities that can be defined as “food deserts” take on an importance that rivals health care services.
Health care in America is changing at a pace never experienced previously. This has brought challenges, excitement, and promise to payers, providers, and the people who entrust their care to us. Consumers, employers, and governments need, and are demanding, high-quality and affordable health care, based on value. We see our evidence-based medicine, technology, research, and the ongoing commitment of our people to deliver high-quality, affordable, patient-centered care as the factors that will continue our success in attaining the Triple Aim.
from Health Affairs Blog http://ift.tt/1Yb9Bkq
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