Transgender Health Meet and Greet

In 2013, we hosted a first conversation, the Transgender Health Care Dialogue. In 2016, we hosted our next, Transgender Health Meet and Greet.

A lot has happened in three years, in our society, in the medical profession, and at Kaiser Permanente. The 2016 event included physicians, nurses, and health leaders from Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Medical Group, and The Southeast Permanente Medical Group.

2016.06.29 Transgender Health Meet and Greet 00715

They joined with the Washington, DC, Maryland, and Virginia LGBTQ community to meet Drs. Kathy Rumer and Rachel Bluebond-Langner to learn about surgical care for people who are transgender or gender non-conforming – hence “Transgender Health Meet and Greet.”

It’s an honor to participate in the future of care delivery at Kaiser Permanente, an organization that values the diversity and inclusion of our lesbian, gay, bisexual, and transgender members (and staff).

Total Health definitely includes the doctors, nurses, and health care system that enable people to live as their authentic selves, as members, as caregivers, as leaders in their communities. I can’t wait to see what happens next.

This Week in Total Health: It’s All About Care

Another busy week wraps up at the Center for Total Health. We welcomed inspiring visitors and conversations ranging from telehealth to heart health, focused both on our own members and the community at large.

On Wednesday, Kaiser Permanente’s Community Benefit team hosted a convening for community practitioners to share our ALL/PHASE protocol, which is a  simple, inexpensive, evidence-based regimen of medications that dramatically reduces the risk of heart attack and stroke among diabetics. The ALL/PHASE program was a winner of the 2010 James A. Vohs Award for Quality and is one of the innovative ways Kaiser Permanente shares information and tools to measure disparities and promote equitable care. The attendees also very literally walked the walk of heart health by joining the CTH team for a 30 minute walk before lunch.

Kaiser Permanente's ALL/PHASE Community Convening

Kaiser Permanente’s ALL/PHASE Community Convening

Michael Adcock, FACHE, Administrator at the University of Mississippi Center for TeleHealth, presents to the Connected Health Coalition.

Michael Adcock, FACHE, Administrator of the University of Mississippi Center for TeleHealth.

On Tuesday, the Connected HealthCoalition hosted an in-person meeting featuring a presentation from the University of Mississippi Medical Center’s Center for Telehealth (@UMMCTelehealth). Michael Adcock, FACHE, the Administrator of the Center for TeleHealth, shared the amazing work going that organization is leading across the state to increase access for all residents to medical care, health education and public health services through telehealth.

 

We were also honored to host an event focused on the transgender community. The “Transgender Health Meet and Greet,”  included physicians, nurses, and health leaders from Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Medical Group, and The Southeast Permanente Medical Group. Our physicians and clinicians hosted two surgeons, along with representatives from the LGBTQ community from Washington DC, Maryland, and Virginia to talk about surgical care for people who are transgender or gender non-conforming. A full post about that event can be found here.

Interns from the Mid-Atlantic Permanente Medical Group

Interns from the Mid-Atlantic Permanente Medical Group

Another thrill for the week – to meet the Mid-Atlantic Permanente Medical Group’s summer interns. These future health care leaders had great ideas about total health, and enjoyed our newest exhibit – a virtual reality tour of Baltimore.

As always, these are just a few of the pictures from the week. The full set can be found here.

Vision Zero for Who? #MoveEquity chat

What opportunities exist to create safer, more equitable streets and neighborhoods?

How can law enforcement be applied more effectively to improve safety in low-income communities and communities of color?

What about the use of safety cameras to lessen the chance of racial profiling?

Last week, we at Vision Zero Network held a twitter chat,  co-hosted with Safe Routes to School Partnership. Lots of people participated and we got many good ideas. A summary of the chat can be found here.

The Vision Zero Network is committed to helping communities reach their goal of Vision Zero — eliminating all traffic fatalities and severe injuries — while increasing safe, healthy, equitable mobility for all.

The Vision Zero Network is a collaborative campaign aimed at building the momentum and advancing this game-changing shift toward safe, healthy, equitable mobility for all. Focusing initially on leading-edge cities demonstrating commitment and potential, the Network will bring together local leaders in health, traffic engineering, police enforcement, policy and advocacy to develop and share winning strategies and to support strong, distributed leadership for policies and practices that make Vision Zero a reality.

We believe a strong, successful Vision Zero campaign can set a new standard for safety on our streets — and build toward a nationwide movement that prioritizes safe, healthy, equitable mobility for all.

You can see how many cities have committed to Vision Zero goals — 18 U.S. cities in just the last 2.5 years– by visiting here.

 

 

National HIV Testing Day

national_hiv_testing_day138
For National HIV Testing Day, we offer this following post written by community practitioners, advocates, activists and researchers with the Kaiser Permanente Community-Based HIV Test and Treat Initiative. Through the initiative they have found that community-based organizations play a critical role in serving people living with HIV when they are able to link their medical care with social, economic and behavioral support services – the total health of an individual. 

—————–

In July 2015, the White House updated its National HIV/AIDS Strategy for the United States, with a vision to ensure that new infections are rare and all people living with HIV (PLWH) have equal and unfettered access to HIV clinical care. Central to achieving this vision for the country’s 1.2 million PLWH are recommendations for widespread linkage to and retention in comprehensive HIV care, support for HIV medical adherence, and achievement of viral suppression. Unfortunately, racial/ethnic disparities persist in linkage to care, retention in care, and viral suppression. Community-based organizations (CBOs), and particularly AIDS Service Organizations, may be better able to provide more tailored approaches to reach and support socially vulnerable and minority PLWH, but there is little guidance in the national strategy regarding how CBOs can support these goals.

For World AIDS Day 2015, we offer our recommendations for CBOs to achieve these National Strategy goals, as a collective of community practitioners, advocates, activists and researchers with the Kaiser Permanente (KP) Community Based HIV Test and Treat Initiative. The Kaiser Permanente HIV initiative began in 2013 and involves implementation and evaluation of innovative community-based and CBO-led interventions to increase linkage to and retention in HIV care among Black and Hispanic men who have sex with men (MSM) in Los Angeles, CA; African American women and transgender women in Oakland, CA; African Americans in the rural and suburban southeast; and people who use drugs and those recently released from prison in the New York metropolitan area. While outcome evaluation findings are not yet available, our collective experience over the past three years demonstrates the following findings to support more effective CBO interventions:

  1. Community-based organizations (CBOs) can play an instrumental role in reaching PLWH, but require strong relationships with clinics to support linkage to and retention in care.

CBOs connected to racial/ethnic minority or socially vulnerable groups (e.g., prison releases, MSM of color, transgender women) and holistic AIDS services may have better reach to PLWH within these communities, than may non-community-based HIV clinics. Through partnership with CBOs, clinics may extend their reach for linkage and retention in care. CBOs with in-house clinical services and those effectively partnered with clinics appear to be most successful in recruiting and retaining patients who have fallen out of care. Culturally and linguistically tailored services were uniformly identified as central to meeting the needs of these clients.

  1. CBOs can support more effective HIV care by helping clients understand and recall medications and information on clinical indicators, such as CD4 and viral load.

While clinical care and initiation of and adherence to antiretroviral therapy (ART) can improve quality and longevity of life, meaningful engagement in HIV care and treatment requires understanding and recall of medication regimens and clinical indicators of health. Many participants reached through this initiative reported recent receipt of CD4 counts and viral load but could not recall the numbers, impeding their use of this information as a means of tracking their health. Low health literacy was also a concern, with participants reporting difficulties reading their medication bottle labels or understanding when to take their medications. CBOs can support patients’ health literacy related to medications and reinforce strategies for recall and interpretation of health indicators following clinical care appointments.

  1. CBOs’ promotion of effective engagement in HIV care for socially vulnerable populations requires support for clients’ linkage to care for key comorbidities, as well.

Vulnerable PLWH commonly present with multiple comorbidities, including substance use and mental health issues, as well as chronic diseases increasingly faced by the nation’s aging HIV-positive population. Linking clients to clinical care broadly, not just HIV care, is critical and may better support more cost-effective funding streams to help sustain CBOs working with PLWH by extending these health support services to vulnerable populations regardless of HIV status.

  1. Life-stabilizing wraparound services and trauma-informed care are needed to support HIV care utilization and medical adherence given the social vulnerabilities faced by PLWH.

HIV care utilization can only be prioritized when their clients’ diverse range of non-medical social needs are simultaneously supported through wrap-around services, including transportation assistance, housing, food security, and group support. A disproportionate burden of abuse histories across the lifespan is also reported among populations served through this initiative, and trauma-informed care and social services have been identified as requirements to support broader HIV and other health care utilization.

  1. Social support as part of palliative care remains an important CBO service for PLWH.

Life-enhancing benefits of ART are not reflected in the health status of our most socially and medically vulnerable PLWH, some of whom learn of their HIV status when they are already at Stage 3 disease progression, rendering a need for complementary palliative care support well into the 3rd decade of the epidemic. Too often social support networks are inadequate for PLWH, and end of life social support from CBO representatives may offer the only non-clinical social support available to these clients. Training and support for CBO staff providing these services is vitally important to help sustain CBO continuity of care.

We offer these recommendations for CBOs to support their capacities to extend the reach of clinical care and link and retain racial/ethnic minority and socially vulnerable PLWH in care, as we believe that elimination of health disparities in care utilization, medical adherence and HIV-related life expectancy requires a community-centered approach best achieved via CBOs. We believe that engagement of CBOs in partnership with HIV clinical care can accelerate the progress of the National HIV Strategy and achieve the Strategy’s vision with regard to “unfettered access to high quality, life-extending care, free from stigma and discrimination.”

Authors:

Kaiser Permanente, National Community Benefit, Oakland CA

Alexandra Caraballo, National Manager, Philanthropy

John Edmiston, National Manager, Community Engagement

Pamela Schwartz, MPH, Director Program Evaluation

Melissa Ramos, Evaluation Consultant

UC San Diego Center on Gender Equity and Health- UCSD GEH, San Diego CA

Anita Raj, PhD, Professor of Medicine and Global Public Health

Lianne Urada, PhD, Assistant Professor of Medicine and Global Public Health

Laramie Smith, PhD, Assistant Professor of Medicine and Global Public Health

Sankari Ayyaluru, Research Coordinator

John Wesley Community Health (JWCH) Institute, Los Angeles CA

Sergio Avina, Division Director

Christopher Hucks-Ortiz, MPH, Evaluation Specialist

Institute for Public Health Innovation (IPHI), Prince Georges County MD

Bradley Boekeloo, PhD, Evaluator, University of Maryland

Abby Charles, MPH, Senior Program Manager

Public Health Institute (PHI), Oakland CA

Tooru Nemoto, PhD, Research Program Director

Mariko Iwamoto, Project Director

The Fortune Society, Long Island City NY

Nilda Ricard, Director Drop in Center-Health Services, Fortune Society

Brendan O’Connell, MSW, Senior Program Analyst

Jahad Robinson, Transitional Specialist

North Jersey Community Research Initiative (NJCRI), Newark NJ

Corey Rosmarin-DeStefano, Director of Clinical Services

Sharif Hall, Data Coordinator

Liliane Windsor, PhD, MSW, Assistant Professor, The University of Illinois at Urbana-Champaign

ASK4Care/Duke University, North Carolina

Beth Stringfield, Project Coordinator

Sara LeGrand, PhD, Assistant Research Professor of Global Health

Women Organized to Respond to Life Threatening Diseases (WORLD), Oakland CA

Cynthia Carey-Grant, Executive Director

Stephanie Cornwell, MA, Program Services Director

Samantha Feld, MPH, Evaluation Data Manager, Cardea Services, Oakland CA

This Week in Total Health: Building for Health

This week, the Center for Total Health met with people designing for total health, whether it’s designing spaces for public health or for a city that supports its residents and their economic health.

Office of Deputy Mayor For Planning and Economic Development - Business Development & Strategy

Office of DC’s Deputy Mayor For Planning and Economic Development – Business Development & Strategy

Health Design Workshop with Green Health Partnership

Health Design Workshop with Green Health Partnership

Sarah Baldauf from George Washington University's Milken School of Public Health

Sarah Baldauf from George Washington University’s Milken School of Public Health

To see all the pictures from this week, check out the full album.

Don’t Let a Failing Heart Relegate You to Endless Doctor and Hospital Visits

Dr. Ameya Kulkarni is an interventional cardiologist with the Mid-Atlantic Permanente Medical Group.

No one wants to spend their days in a hospital room. For the more than 5 million people in America who live with heart failure, a hospital stay is an unfortunate fact of life. In fact, it is estimated that there are over 1 million hospitalizations for people with this condition every year. The burden on patients, their families and their communities is immense. And the cost of this care is so high that there is a currently a national focus on trying to drive down admissions to the hospital for heart failure.

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

So far, the ideas on how to solve this problem mostly treaded old paths – exchanging hospitalizations for more doctor office visits. We know that patients end up in the hospital when they fill with fluid. Signs of this fluid buildup (increased weight, decreased activity) usually show up well before the need for a hospitalization. Our solution so far has been to have patients come to the doctor’s office more frequently for weight and activity checks. Although cumbersome for both the patient and the clinical care team, at least coming to the doctor every week keeps these patients out of the hospital.

It does not, however, make patients happier. Although no one wants to be in a hospital, few long for frequent battles with traffic only to pay a copay and wait for a doctor to review their weight and activity and make a small medication adjustment.

The innovation team at the Mid-Atlantic Permanente Medical Group – the independent medical group that exclusively serves Kaiser Permanente members in Washington, D.C., Maryland, and Virginia – has a vision of using 21st century technology to keep a close watch on our patients without the burdens of the traditional face-to-face visit.

We know that an early signal that a patient with congestive heart failure (CHF) will land in a hospital is a decrease in activity or an increase in weight. So we are giving our patients connected monitors that measure these parameters and send them to the care team automatically. We do the rest. When patients are doing fine, we don’t bother them. But when we get a signal that things aren’t going so well, we can reach out to make an adjustment before the fluid retention gets out of hand.

Better Together Health, with Council of Accountable Physician Practices

KPCTH -2016.06.15 Better Together Health with Council of Accountable Physician Practices 00603

Innovations in chronic care were featured in the Council of Accountable Physician Practices (CAPP) event at the Center for Total Health on June 15.

Hosted by The Permanente Medical Group Executive Director and CEO Robert Pearl, MD, the event was keynoted by Senator Johnny Isakson (R-GA), co-chair of the Senate Finance Committee’s Chronic Care Working Group. A lively panel discussion moderated by Ceci Connolly, President and CEO of the Alliance of Community Health Plans (ACHP), included patient stories that highlight the importance of care coordination and patient engagement in managing chronic conditions. Kaiser Permanente Southern California’s “complete care” diabetes program was featured through a member video and a description from Dr. Marc Klau, SCPMG Assistant Regional Medical Director for Education, Learning and Leadership. Tim Gronninger of CMS also gave remarks and joined the panel for questions.

KPCTH -2016.06.15 Better Together Health with Council of Accountable Physician Practices 00585

The Council of Accountable Physician Practices also released its second annual poll of patients and physicians, which measures patient expectations, use of technology enabled care, and the pace of progress in bring “high tech, high touch” care to patients while making it easy for physicians and the care team to provide.

Hepatitis C: It’s Curable, So Let’s Find the People who Need to be Cured

Dr. Michael Horberg is Executive Director Research, Community Benefit and Medicaid Strategy of the Mid-Atlantic Permanente Medical Group (MAPMG) and the director of the Mid-Atlantic Permanente Research Institute (MAPRI). Carla Rodriguez , PhD, MPH, and Cabell Jonas, PhD also contributed to this post. 

Too often, news coverage of hepatitis C focuses on the cost of new drugs and not the importance of determining which patients have hepatitis C and getting them into effective care.

hepc

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

An estimated 50 percent to 80 percent of those with hepatitis C are unaware of their infection. Experts believe that is a group of some 800,000 people. Screening them all could prevent 120,000 deaths – not to mention stop the spread of infection to others. Simple blood testing and liver damage assessment, seems like a low price to save 120,000 lives – or thought of differently, preventing a deadly plane crash every day for the next year.

It is well known across medicine who should be screened (everyone born between 1945 and 1965, plus at-risk individuals such as those with HIV or patients on kidney dialysis, men who have sex with men, and people who have used injectable drugs now or in the past). But we at the Mid-Atlantic Permanente Research Institute (MAPRI), the institutional research arm of Kaiser Permanente of the Mid-Atlantic States and the Mid-Atlantic Permanente Medical Group (MAPMG), set out to find a way to actually make it happen. Data suggests only a few percent get screened (0.7-12.7 percent) – and less than half of those end up actually linked to care they need. If others could adopt our innovative program, the impact could be tremendous.

Knowing the problem is half the battle. We found that most doctors have a hard time remembering when to recommend their patient be screened. And, for those doctors who order the screening, patients may still not follow through because they need to complete three discrete steps (an antibody blood test, an RNA blood test, and liver imaging or biopsy). Therefore, our solution carefully addressed each problem. The solution:

  • Automated alert when doctors open charts during visits with patients who match screening criteria
  • The antibody blood test is linked to an order for the confirmatory HCV RNA test (meaning blood is collected at a single visit to the lab rather than asking the patient back for a second blood draw for the HCV RNA test)
  • Provided for a dedicated coordinator who could make sure no one fell through the cracks and helped them get the liver damage testing they may need contingent upon blood test results as well as linkage to ongoing care from their physician or a specialist
  • Offered patients a non-invasive, pain free liver damage assessment rather than a biopsy (when clinically feasible)

New peer-reviewed research shows that the integrated screening approach is working. Screenings are up dramatically, those who start step one of screening are getting a complete diagnosis and linkage to care

While the cost of treating hepatitis C is no doubt an important issue, we also need to pay attention to and champion screening advances that will help us do a better job of diagnosing and stopping the spread of this deadly virus.

Preview: Better Together Health Returns to CTH

Next week, the Council of Accountable Physician Practices (@accountableDOCS) will host the second in a series of Better Together events at the Center for Total Health. The program will focus on patient expectations accountable physician practices.

The transformation of American health care means more than reducing costs and improving quality scores. Healthcare systems have to focus on closing the gap between what patients actually want and what they are experiencing, especially for those with chronic illness. How can we bring true accountability to the system? The Council of Accountable Physician Practices and the Bipartisan Policy Center invite you to hear patients and doctors tell their stories of what patient-centered care really looks like.

To attend in person or gain access to the live webcast, REGISTER HERE.

The first event, focused on technology-enabled interactions between patients and physicians. Two of the personal patient stories shared at the event – Emma, a baby with severe burns, and Karen, an oncology patient- can be seen here.

If you have questions about this year’s event, please contact Elizabeth Keating via this link.

 

Two Weeks in Total Health: We’ve Been Busy!

The week of May 16 kicked off with a two-day Ragan Public Relations (@RaganComms) Measurement Summit. One of the most important tasks we have as a health organization is communicating with our patients, providers, employees, and suppliers about health, and there was much to learn from colleagues from all types of companies — from AARP to NASCAR.

On Wednesday, May 18, Health Affairs (@Health_Affairs) hosted The Future of Individual and Small Group Markets, a forum on the sustainability of these markets and potential changes to market regulations. Kaiser Permanente’s own Kitty Guptill, senior vice president, strategic market planning, participated in the event as an expert.

Kitty Guptill, Senior Vice President, Strategic Market Planning at Kaiser Foundation Health Plan, presents during the Health Affairs Forum

Kitty Guptill, senior vice president, strategic market planning at Kaiser Permanente, presents during the Health Affairs Forum on the Future of Individual and Small Group Markets on May 18, 2016.

 
See photos of the rest of the week here.

The week Of May 23 started with a roundtable meeting of industry experts hosted by the National Committee for Quality Assurance (@NCQA). NCQA convenes this group representing companies that have a stake in its work as an evaluator of health plan and clinical quality throughout the year.

NCQA Industry Council

NCQA Industry Council Members

The rest of the week has been dedicated to much-needed technology and facility maintenance projects. Though it might seem like a light week, these projects have kept us quite busy.