Joanne Schottinger, MD, at Cancer Care Delivery in a Rapidly Changing Healthcare System

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Left to Right: Carolyn Clancy, MD (U.S Department of Veterans Affairs) Ann Geiger, PhD (National Cancer Institute), Joanne Schottinger, MD (Kaiser Permanente) (View on

Washington, D.C was host to ECRI Institute’s Cancer Care Delivery in a Rapidly Changing Healthcare System, which featured Joanne Schottinger, MD, representing Kaiser Permanente in “How do integrated delivery systems provide cancer care?”

And the answer is…comprehensively, as the data shows, for example: Kaiser Permanente Share | Reducing Disparities in Colon Cancer Through Integrated Care which is part of the larger Complete Care Program: Kaiser Permanente Share | ‘Complete Care’ Improves Patient Outcomes

Schottinger noted that Kaiser Permanente delivers 250,000 chemotherapy treatments per year, 4,000 of which are part of clinical trials. This along with our electronic health record system allows greater insight into caring for patients in real world situations that supplements the latest research-based evidence used to guide care.

Transit, Health, and Gardens, with Greenbuild, American Institute of Architects, and District Department of Transportation

2015 Greenbuild Tour Bike DC- Transit, Health, and Gardens Kaiser Permanente Center for Total Health 00238

2015 Greenbuild Tour Bike DC- Transit, Health, and Gardens Kaiser Permanente Center for Total Health 00238 (View on

Following on a similar bike tour in September (see: Buildings, Bikes, and Gardens with DesignDC ), the Kaiser Permanente Center for Total Health (@KPTotalHealth) hosted this one, as part of the very large Greenbuild International Conference and Expo that was in Washington, DC this year.

In addition to demonstrating the ways that health care contributes to a healthier built environment (who, us?) the following speakers dialogued with the group on work to promote bicycling:

  • Jim Sebastian of @DDOTDC
  • Steve White, director of Fentress Architects and president of AIA DC (@steve_aiadc)
  • Paul Balmer, legislative assistant to Congressman Earl Blumenauer from Oregon on the Congressional Bike Caucus (@PBalms)
  • Caron Whitaker from the Bike League (@CaronWhitaker)

A lot of where this comes together at Kaiser Permanente can be found at our Westside Medical Center, in Hillsborough, Oregon, which is one of the few (less than 60) LEED Gold certified medical centers in the world. You can read more about it here.

Thanks for letting us take part in Greenbuild!

How to mutate your DNA, and how health systems can heal the planet, with American University’s PUBH115 students

2015.11.16 American University Class PubHealth 115- Why Aren't We Dead Yet? Role of Public Health in Society at Center for Total Health 00150

2015.11.16 American University Class PubHealth 115- Why Aren’t We Dead Yet? Role of Public Health in Society at Center for Total Health 00150 (View on

Because we are The Center for Total Health (@KPTotalHealth), everything health related is in scope. Because we are Kaiser Permanente, healing people and the planet is in scope.

With that in mind we were happy to tour American University’s Professor Lynne Arneson and students in her undergraduate course “PubHealth 115: Why Aren’t We Dead Yet? Role of Public Health in Society

The great thing for total health is that all of these concepts are accessible to everyone in the health system. My colleague Erin Meade (@erinm81) remarked as we prepped for the tour that our endocrine systems are better off without disruption. I agree, so I’m glad we’re doing all the things we are to allow people’s hormones to work as intended.

Kathy Gerwig (@KathyGerwig), our environmental stewardship officer for Kaiser Permanente – wrote this blog post which was perfectly timed for the students’ experience: 10 ways hospitals can heal the planet | OUPblog

Joel Sigler, CSP, HEM, from Kaiser Permanente National Environmental Health & Safety, discussed KP’s efforts to remove harmful chemicals and reduce waste in the Kaiser Permanente System, a good family doctor knows what they don’t know, and invites those who do know to join the conversation…

I’m really glad that we’re able to tell a story about how public health and health care work together to heal people and communities at Kaiser Permanente – it’s something that didn’t seem possible during my medical training, and now it clearly is. One more reason why I love this century :).

2015.11.16 American University Class PubHealth 115- Why Aren't We Dead Yet? Role of Public Health in Society at Center for Total Health 00146

Getting ready to host American University Class PubHealth 115- Why Aren’t We Dead Yet? Role of Public Health in Society at Center for Total Health – with Elena, a parent with a child who has asthma (View on

Delving into the Data of Diabetes – A Research Roundup

By Muriel LaMois and Natalie Kish

The Centers for Disease Control and Prevention recognizes November as National Diabetes Month. It represents a time to increase awareness for and understanding of living with diabetes. Nationwide, nearly one out of 11 people has diabetes, and more than one-third of adults are pre-diabetic. Kaiser Permanente treats many of its members with these conditions, and researchers across the organization study diabetes-related health issues to determine how to better serve these individuals.

Stabilizing Trends in New Cases of Diabetes

Several Kaiser Permanente regions participated in a study published in January 2015 aimed at determining trends in new diabetes cases in 11 integrated health systems from 2006 through 2011. After analyzing the health records of approximately seven million newly diagnosed diabetic patients aged 20 and older, researchers found no statistically significant increase in the number of diabetes cases between 2006 and 2010 – with the exception of a small rise in cases in 2011. However, they found significant increases in diabetes cases for certain groups, including racial and ethnic minorities, older adults, males, and people with higher body mass indices. Despite the relatively stable overall rate of new cases, these results suggest that new cases of diabetes are appearing more often in certain populations than in others. Gregory Nichols, PhD, Senior Investigator with Kaiser Permanente’s Center for Health Research, led the study.

Regional Trends in Existing Cases of Diabetes: In Northern California Ethnic Disparities Reduced

Andrew Karter, PhD, and researchers from the Division of Research, conducted a study to evaluate ethnic differences in the severity of existing diabetes-related complications. Study participants included Kaiser Permanente Northern California members with diabetes who were at least 60 years old in 2010. The complications included: myocardial infarction, stroke, heart failure, amputation, end-stage renal disease, advanced diabetic eye disease, and hypoglycemic events. Among those who were studied, 32 percent of patients had at least one complication in the past two years, with eye disease and heart failure occurring most often. Karter and his team also found that certain ethnic groups were more likely to have diabetes-related complications. According to the research, Whites have the highest prevalence for most diabetes-related complications and Asians and Filipinos have the lowest prevalence. The differences in the prevalence of complications between ethnic minorities were modest. These results suggest Northern California is making progress toward reducing health disparities of diabetes-related complications among existing patients who already have diabetes.

Kaiser Permanente Southern California Improves Detection of Diabetes-Related Eye Disease

Diabetic retinopathy is the leading cause of blindness among adults in the United States. A project conducted in Kaiser Permanente’s Southern California medical centers sought to improve diagnostic accuracy of this condition by implementing a centralized reading center that assigned a single team of technicians to assess images for diabetic retinopathy for all of the region’s facilities. The center allowed for physicians to have more time for patients who needed to see them; specially trained technicians to provide more consistent and accurate readings; and photographers to get feedback that improved their images. Most importantly, it allowed more patients with diabetes to learn whether they have potentially sight-threatening retinopathy, and receive appropriate education and treatment. Recently the retinopathy center initiative received the David M. Lawrence Patient Safety Award in recognition of the project’s impact on improving the safety of care for patients and accelerating the rate and scope of patient-safety improvements at Kaiser Permanente.



Make Today a Little Sweeter

November is American Diabetes Month. According to the American Diabetes Association, nearly 30 million Americans have diabetes, while 86 million have pre-diabetes and are at risk for developing type 2 diabetes. While there are some risk factors for diabetes that you can’t change, knowing your risks lets you decide what’s best for your health. This fall, take time to make and celebrate healthy changes. Some ideas:

Play detective: Find out what you don’t know about your family history, especially when it comes to chronic conditions.

Stay in check: Low blood sugar levels can cause sudden mood swings in some people, so don’t go too long between eating meals.

Indulge smart: When you want to satisfy your sweet tooth, be mindful of your choices. A serving of berries is almost always better than a pastry or chocolate.

Form more information, visit

The Quest for Quality Care: Informing Clinical Decisions in an Integrated Health Care System

horbergEver-expanding health care costs have led to increased scrutiny of treatments and a new emphasis on value. In response, providers are seeking to improve clinical decision making by considering various factors, such as the effectiveness of different interventions, side effects, and how patients want to live their lives. Bringing these variables together is an example of the intersection of comparative effectiveness research and shared decision making between clinicians and patients.

Comparative effectiveness research allows healthcare professionals to compare different drugs, technologies, and care processes to ensure that they are best serving patients. Kaiser Permanente’s integrated health system, serving 10.1 million people across the nation, is uniquely suited for this kind of research. Michael Horberg, MD, MAS, one of the organization’s leaders in this space, discussed why this is true.

Michael Horberg, MD, MAS is the Executive Director of Research for Kaiser Permanente’s Mid-Atlantic Permanente Medical Group and Mid-Atlantic Permanente Research Institute

What role does an integrated health system with shared decision making like KP play in comparative effectiveness research?

Our goal is to conduct comparative effectiveness research on established processes or technologies to improve patient care.

The key aspects of clinical decision making are the patients’ wants, needs, aspirations, and their life stage. Research can always be very biological—for example, Drug A lowered blood pressure more than Drug B, so Drug A is superior—that doesn’t consider other factors, such as how often Drug A has to be taken. Drug A may be successful under ideal circumstances, but it may not produce the same effect in real-life situations, and FDA’s approval of a drug and patients’ willingness to take the drug don’t always align.

What’s important is synthesizing information for patients. In a non-integrated system, there isn’t a systematic way to make the decision between Drug A and Drug B. There is also not a method to weigh this data. In small fee-for-service practices, the doctors’ decisions may be based on a small sample of patients or lobbying by drug companies. At KP, we can collect information from a large sample of patients without industry influence and make more well-informed decisions.

Many stakeholders believe that comparative effectiveness research will have a moderate to substantial impact on healthcare decision making in the next five years. Where do you see it by 2020?

Comparative effectiveness is going to be critical, especially as patients become more engaged in care and more drugs, technology, and care processes become available.

Because patients are the center of care, we will see more talk about how to bring them into the decision making process and into research. A lot of the questions research scientists think are very clear in our minds can be broadened by incorporating patients’ perspectives.

We will also start to see a lot of people and organizations talking about the effectiveness of different technologies and practices. For example, in pharmaceuticals, we will see more studies comparing generic medications and branded prescriptions, as well as comparing different branded drugs. As we observe just minor gradations of improvement of one product over a previous product, people will start asking about the significance and magnitude of the added benefit or if there is any extra value at all.

To learn more about comparative effectiveness research at KP, please see the pages for the Mid-Atlantic Permanente Research Institute and the Center for Effectiveness and Safety Research.

Walking, Talking, Ward 8 Visualizing at the Walking Summit

Walking Summit Ward 8 Walk and Talk Washington DC USA00281

Walking Summit Ward 8 Walk and Talk Washington DC USA00281 Left to Right: Rosemary Agostini, MD, Kim Holland, MD, Group Health Cooperative, Jojo Cambronero, Seattle Police Department (View on

Sometimes you can’t take people passionate about walking anywhere — that is, unless you are interested in changing everything, then you should go with them everywhere :) .

Thanks to community colleague Khadijah Tribble (@TribbleME) and fellow organizers, a group of nurses, doctors, law enforcement professionals, and other civic leaders walked in Washington, DC’s Ward 8.

If you don’t know what is meant about Ward 8, not to worry, the blog way-back machine will bring you back to my very first meeting with Khadijah, where she walked us through her community (see: The People of Washington, DC’s Anacostia are Building a Culture of Health ).

What I love about yesterday, though, is that Khadijah instructed us to not focus on what wasn’t right with the community as we walked it. Instead, she asked us to focus on its beauty. And there’s a lot of beauty.

We were joined by a team from Seattle, including my physician colleagues Rosemary Agostini, MD, and Kim Holland, MD, who are community health evangelists as part of the magical health system of the future, Group Health Cooperative (@GroupHealth). They’ve been doing a ton of work to engage people around walking in their city, and have engaged collaborators in the Seattle Police Department, who also joined us.

And that’s when our learning experience went to the next level…

In true Rosemary Agostini fashion, she engaged a group of Washington’s Metropolitan Police Department officers in Congress Heights to talk about community and engagement and safety. As you can tell from the photographs, it was a meaningful, authentic conversation.

On the way back to Ward 6, I got to learn about how community engagement and crime fighting work together to support a healthy community.

As it was said to me, “you don’t get information from people when you arrest them, you learn by engaging them.”

As usual, I see a lot of similarities to medicine and health care – disease fighting (or disease pre-emption) + member, patient, community involvement go a long way to understanding what creates health, and what prevents it.

I was really impressed by what I saw, by all the people involved. I obviously love learning, and I love learning how similar our perspectives are when it comes to ensuring that every person and community achieves their full potential. What is health care here for, and law enforcement, and civic leaders, and …. :)

Congratulations, President Sandy!

Last night, the Center for Total Health was thrilled to host the annual meeting of the Medical Society of the District of Columbia (MSDC, @MedSocDC).

This year’s meeting was particularly special and exciting, as Kaiser Permanente’s own Carla Sandy, MD, was installed as President of the MSDC. Dr. Sandy is a practicing OB/Gyn specialist at Kaiser Permanente Capitol Hill Medical Center in Washington, DC and Service Chief, Obstetrics and Gynecology, District of Columbia/Suburban Maryland, Mid-Atlantic Permanente Medical Group.

Carla Sandy, MD, President of the Medical Society of DC, with three past presidents.

Carla Sandy, MD, President of the Medical Society of DC, with three past MSDC presidents.

The evening included remarks from Director of the District Department of Health, LaQuandra S. Nesbitt, MD, MPH (@DrLNesbitt), and presentation of awards to some of the best and brightest in the city. Truly an honor to host here at the Center for Total Health.

Look at all these Permanente physicians!

Look at all these Permanente physicians!

Carla Sandy, MD – The Total Health / MSDC Presidential Interview

Studio portraits for Carla Sandy. Photo by Delane Rouse/DC Corporate Headshots.

Carla Sandy, MD.

On October 28, 2015, Carla Sandy, MD, will be installed as the President of the Medical Society of the District of Columbia at the Kaiser Permanente Center for Total Health.

Dr. Sandy is a practicing OB/Gyn specialist at Kaiser Permanente Capitol Hill Medical Center in Washington, DC and Service Chief, Obstetrics and Gynecology, District of Columbia/Suburban Maryland, Mid-Atlantic Permanente Medical Group.

The Center for Total Health team chatted with Dr. Sandy recently about her thoughts on Total Health and the Presidency.

All members of the community are welcome to attend the 2015 Annual Meeting and Reception of MSDC – click here for more information

1. In a few words, what does Total Health mean to you?

It’s the physical and emotional connection, and making sure it is taken care of optimally. As physicians, we are good at finding physical signs and symptoms. We need to dig to find out what the real causes are of less-than total health.

I ask my patients questions such as “what else is going on with you,” and “what is your work environment like.” I’ll take a few more minutes to figure out what it is (that’s keeping someone from total health). I tell patients, the nice thing about talking to me is that you’re talking with someone confidentially, which gives a patient permission to disclose what’s going on in their life.

2. What’s your first health-related memory?

Chicken pox. That was not a fun time at all.

3. Was there a specific patient that has had an impact on you in your training?

In my second year of training – I had a really difficult patient, a teen, 17-18. It was her second pregnancy, and she was living in a very unstable home situation. We ran a clinic where I trained, at Washington Hospital Center, for teen moms. One day I was expressing frustration over this patient and one of my attendings said to me, “Despite how she’s making you feel, she still needs us.”

4. Which person, living or dead, is your health hero or role model?

My grandfather is my health hero. He is 101 years old and still active. Every day he gets up and walks out to his fruit trees and picks something to eat. In addition to a plant based diet, he exercises daily and takes time for spiritual rejuvenation and meditation. He is an inspiration to me.

5. What is your favorite food?

Macaroni and Cheese. I should have probably said something like apples…. but, everything in moderation!

6. What do you value most in your work? What inspires you to continue?

Definitely direct patient care. I will always have some type of patient care somewhere in my career. Most of the physician leaders in the Mid-Atlantic Permanente Medical Group still engage in direct patient contact and I think it’s important to keep that piece.

7. Where would you most like to live?

I always wanted to live in Manhattan, and my husband always asked, “Why?”

A few months ago, I went to a conference in Manhattan and realized I could never live there.

8. What do you consider your greatest achievement so far?

Being Chief of the Department has meant the most to me in my career. It’s not only a validation of the work I’ve been doing, earning the respect of my boss and my Department, it’s also knowing they respect me and that we work together cooperatively to improve patient care.

9. What health disparities are you passionate about?

As an OB/Gyn, I’m concerned about maternal access to care and the quality of care. I work with a patient population that has a higher rate of pre-term deliveries. We’ve been working to mitigate the risk factors to see if we can change the narrative and improve those results.

10. Besides your leadership role within Kaiser Permanente, you have recently been elected as president of the Medical Society of DC. What excites you the most about that new role?

I’ve been on the MSDC Board for three years, and MAPMG is one of the largest medical groups in this area.

There is an ongoing shift of physician practice types. More and more physicians who are employed instead of in private practice. I am showing the physician community that yes, things have changed as more physicians are employed and that’s very different. However, we still have the same patients who have the same issues. The reason I said “yes” then, is to show that I am a physician first and I still have the same concerns about my patients receiving the best care. As physicians, we need to stand together.


Physician Leadership with Bernadette Loftus, MD and Bill Wright, MD at National Association of Accountable Care Organizations

Blog written in collaboration with Joy Lewis (Kaiser Permanente Institute for Health Policy) and Ann Kempski (The Permanente Federation)

Permanente Medical Group Leaders Bernadette Loftus, MD and Bill Wright, MD, took to the podium (and the dinner table!) at the National Association of Accountable Care Organizations Fall conference and Kaiser Permanente Center for Total Health in Washington, DC.

They led discussions based on the experience of the Mid-Atlantic Permanente Medical Group and Colorado Permanente Medical Group, on the topic of physician-hospital relationships, and how to collaborate effectively.

The plenary session was apropos for an audience of about 500 individuals, mostly comprised of leaders of private and public accountable care organizations. Private and public accountable care organizations (ACOs) are becoming well established, with some 750 such organizations operating in the U.S. as of January 2015 A particularly vexing challenge is the structuring of relationships among physicians and hospitals to support hospital care quality, service, and affordability.

A few issues drive this challenge:

  1. Nearly one in four ACOs are not partnered with a hospital and therefore may lack the collaborative relationship that may be necessary for improving care and cost;
  2. ACOs that are not partnered with a hospital rarely know when their patients have been admitted and therefore cannot influence inpatient care;
  3. Even among hospitals that are financially integrated with ACOs, there is no significant difference in total cost of care for patients, which suggests that factors—such as leadership, culture and governance—may be more important than financial integration in helping doctors and hospitals collaborate effectively.


Bernadette Loftus, MD and William Wright, MD NAACOS15 09637

William Wright, MD at NAACOS 2015

Dr. Loftus and Wright covered topics including:

  • Contracting and consolidating business with a single hospital (or a few core hospitals).
  • Health Information Exchange: how are data, best practices, and quality improvement projects undertaken collaboratively?
  • Physician leadership in hospital operations (via opportunities such as a JOC: Joint Operating Committee)
  • Overall strategies for establishing successful relationships with hospitals

Only four hands out of the hundreds in the room went up when asked if they had existing Joint Operating Committees as a part of their contracts with hospitals. Our leaders seeded some ideas with the ACO community, and we anticipate future opportunities to continue the conversation.

Bernadette Loftus, MD and William Wright, MD NAACOS15 09594

Bernadette Loftus, MD, and William Wright, MD at the Kaiser Permanente Center for Total Health

The evening prior, Drs. Loftus and Wright led a discussion with a smaller group of physician leaders at the Kaiser Permanente Center for Total Health (@KPTotalHealth). Comments from guests included:

“It’s a very rarified atmosphere (at Kaiser Permanente)”

“We are all dancing around the edges of KP”

As we have seen previously in Washington, DC, a story of clinical excellence is especially powerful when told by those who are continuously innovating and improving, solving problems, and managing the challenges of growth.

The events showed how relevance is enhanced by the high performance of the Kaiser Permanente Colorado (@KPColorado) and MidAtlantic States (@KPMidAtlantic) Regions of Kaiser Permanente (see: Kaiser Permanente Share | Kaiser Permanente Medicare Plans Score Top Ratings for Quality and Service).

Washington, DC and the Kaiser Permanente Center for Total Health continue to be important venues for physician leaders responsible for our clinical excellence to connect with audiences eager to listen and ask questions about the future.


David Muhlestein, “Growth and Dispersion of Accountable Care Organizations in 2015,” Health Affairs Blog, March 31, 2015.

Carrie H. Colla, Valerie A. Lewis, Stephen M. Shortell and Elliott S. Fisher, “First National Survey Of ACOs Finds That Physicians Are Playing Strong Leadership And Ownership Roles,” Health Affairs, 33, no.6 (2014):964-971.

Michael McWilliams, Michael E. Chernew, Bruce E. Landon, and Aaron L. Schwartz, “Performance Differences in Year 1 of Pioneer Accountable Care Organizations,” New England Journal of Medicine, 2015; 372:1927-1936.

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