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

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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.


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.


Help Us Write Our Veteran’s Story

dominiquwOn Memorial Day, we recognize and honor our fallen soldiers, those who have made the ultimate sacrifice. We also thank those who have returned home forever changed. At the Center for Total Health, we remember veterans every day with one of our personas, Dominique.

When we refreshed the content at the center last summer, we added several sculptures to represent a diverse set of individuals and their total health stories. Some of their stories were fully written, but some we decided to leave open and have our guests help us write. Dominique is one of those. So, even if you are unable to visit the center, we’d love to hear what you think her personal story is, in terms of her health and in general.

In the comments section below, share your ideas with us.

  • What do you think is on her mind? Is she worried? Optimistic? Determined? Depressed?
  • Does she look healthy?
  • How do you see her, beyond her amputation?

We’ll compile your ideas with those we’ve heard from hundreds of visitors since last September to write a formal story for Dominique. There is no wrong answer or bad idea!


Bike to Work (or Lunch) Day 2016

Across the country, bike commuting grew 62% from 2000 to 2014. Washington, DC is among the top ten cities for bike commuters with over 13,000 in 2014 (an increase of 124% from 2005) according to the League of American Bicyclists. As the annual Bike to Work Week and Bike to Work Day (both of which fall right in the middle of Bike Month) is upon us, the Center for Total Health team hit the streets for a mid-day bike break.

Bike commuting isn’t for everyone – some people may not have access to a bike, may not feel comfortable riding on city streets, or may simply work too far from home. However, for those who are able and interested, DC’s Capital Bikeshare provides an affordable opportunity to access bikes. Since arriving in DC in 2008 (as SmartBike DC), Capital Bikeshare has become increasingly popular. In the past six years, Capital Bikeshare has grown from 114 to 378 stations, with a total of 12.8 million trips as of April 2016. This system has undoubtedly contributed to the increase of bike commuting in Washington, DC and across the region.


In honor of Bike to Work Day, our team took a mid-day break to Bike to Lunch together. If biking isn’t for you, consider commuting on foot to celebrate active transportation and build exercise into your day. And please, don’t forget a helmet if you’re getting on a bike today. After all, bike helmets are the new seatbelt.


This Week in Total Health: Keeping it in the KP Family

This week, the Center for Total Health team got to spend time with hundreds of our Kaiser Permanente colleagues. The week began with training sessions for DC and Maryland area Ambulatory Surgery physicians, nurses, clinicians, and staff. It was a thrill to get to spend some time with these incredible people.

We also welcomed colleagues from Kaiser Permanente’s Health Plan Institute, Kaiser Permanente Ventures, and the Kaiser Permanente Institute for Health Policy. These groups reminded us of the incredible, diverse, and passionate people working to serve our members every day.


Colleagues from Kaiser Permanente’s Health Plan Institute & Kaiser Permanente Ventures visit the CTH Farmers Market


First Mother’s Day Without Mom

Patti Harvey, senior VP, Medicare Clinical Operations and Population Care, and executive director, Care Management Institute, has been a nurse for years, but nothing in her training prepared her for her role as her mother’s caregiver.

On Mother’s Day, I will be thinking about the enormous influence my mother had on my life and work.

Over the past 10 years, I have felt a strong personal connection to my work as a leader in care delivery at Kaiser Permanente. Even before then, my mom had joined KP as a member in 2002, after she and my dad moved to California to live with my family. My dad passed away in 2003 and my mom was a constant in our family for many years, providing care and comfort to all of us.

My mother passed away in November of 2015, so this will be my first Mother’s Day without her. She was not healthy for many years. She smoked cigarettes for almost 40 years and was plagued with almost every bad thing that smoking can do to a woman’s body, except cancer. I was her primary caregiver for 13 years, with help from all of my family.

I have been a nurse for many years, but my role as a caregiver for my mom was one that nursing school and graduate school did not prepare me for. My mom’s needs were complicated and she required support at home during the day while we were off working and going to school. We learned that caregiving for a loved one can create a physical, emotional, and financial burden for the entire family. Our KP members and employees have these same challenges.

My children learned to give insulin and breathing treatments. Walkers, wheelchairs, oxygen, many medications, and frequent trips to the doctor and hospital were a routine part of our lives. These were the physical things, but my mom made each one of us feel special and kept us smiling and enjoying her Texas humor. She told us what she wanted and needed and we worked to make it possible.

Her doctors and nurses knew her and she was a part of their family. Her primary doctor and I are good friends, and KP nurses at the Thousand Oaks clinic have my cell phone number. Her doctor was my support, too. We cried and laughed together trying to keep my mom strong. When it came time for him to have conversations about how my mom wanted to be cared for in her final days, he could not bring himself to talk to my mom about dying. He loved her and wanted to help in any way he could. My mom and I had conversations about what she wanted if she couldn’t make her wishes known. We completed her advanced directives and medical power of attorney.

Still, she had a lot to live for and she set goals for herself. She wanted to see my daughter graduate from college, she wanted to see my middle son graduate from college and pursue his love of flying, and she so wanted to see my baby boy graduate from high school. I am so thankful that she was able to accomplish these things in her life.

My mom fell and broke her leg and her health and well-being deteriorated rapidly. She was in the hospital and had gone through so many painful procedures, she couldn’t eat or sleep. She finally said she didn’t want to do this anymore and asked me to get her doctors to come to her bedside.

Later that afternoon, her hospitalist, her surgeon, her case manager, the nurse executive, her nurse, and I had one of the most powerful conversations of my life. My mom asked us to sit at her bedside and she began to tell us her wishes. Her doctors were both women and my mom said, “I am going to talk to you like I talk to my daughter because I have grown to love all of you. I want some tomato soup, I want to sleep until I wake up, I want to leave the hospital and go somewhere that has flowers and good smells. I don’t want any more pokes, tests, and pain. I want to go home.”

This conversation left us all in tears. Her hospitalist asked my mom, “Mary, what end-of-life care would you like?” My mom looked at me and said, “What the heck did she say?” I asked her doctor to rephrase the question: “Mary, what does a good day look like to you?” When her doctor asked her that question, her eyes sparkled, her voice lifted, she smiled and told us all stories of what a good day for her is. Later that day, her surgeon brought her some homemade tomato soup and ice cream.

My mom passed away five days later with my baby boy and me by her side. My grandson was born two weeks after my mom passed. She is his guardian angel and we will tell him stories of his angel “Nanny” and how she is with him.

I am sharing my story for two reasons. One is to remind me and those I get to touch that we have an opportunity to make the lives of those we serve better and to support their well-being throughout all stages of life. To do that we must listen and respond. The second reason is to help others understand the power of the voice, presence, and partnership of our patients and their families. Without listening and responding to my mom’s wishes, she wouldn’t have had her last good days.

Now to end this chapter in my story, I am a “granny.” Every day I try to make my grandson’s life better; and at work, I try to make our patients, their families, and my colleagues lives’ better — by listening, responding, and ensuring that we don’t lose sight of what we are blessed to get to do each day.

Happy Mother’s Day, Mom! Thank you for all you give me and us every day.

Categories: Guest Blogger