Blog & Bloggers

The Future of Employer-Based Health Care Coverage: A Conversation with Institute for Health Policy Advisory Board Member Kevin Schulman, MD

Editor’s Note:  This post and accompanying Q&A is authored by Ben Wheatley with the Kaiser Permanente Institute for Health Policy.

In a recent Perspective published in the New England Journal of Medicine titled, “Shifting toward Defined Contributions — Predicting the Effects,” Kevin Schulman, MD, discussed the increasing number of employers that are moving to defined contribution strategies in providing health care for their employees.

For employers, this move limits their financial exposure to rising health care costs by shifting the cost burden. Instead of negotiating rates with health insurance companies, employers contribute a capped amount toward their employees’ care, which gives them a suite of options for choosing coverage – along with added obligations in paying for their care as costs increase over time.

Kevin Schulman, MD

Kevin Schulman, MD

As the trend towards defined contribution grows, the nature of employer-based coverage begins to change. Institute for Health Policy Advisory Board Member Kevin Schulman, a professor of medicine in the Duke University School of Medicine and director of the Center for Clinical and Genetic Economics, discusses the implications of this shift.

Ben Wheatley: Ten years from now, will employer-based coverage as we know it still be around?

Kevin Schulman: This is one of the most interesting questions in health policy today. There are many problems with the current employer-based coverage system: it can limit flexibility in job choice, limit entrepreneurship, and, in a global marketplace, it can make American exports look more expensive next to products from countries where health care is funded differently.

The migration to defined contribution begins to break the bond between employment and coverage. Under this new approach, employees are really the ones purchasing their health benefits, and thus pay more of their own health care costs and will want to have more flexibility in their benefit choices.

Read the entire interview.
Please note: The views expressed in this article are not those of Kaiser Permanente.

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A Perfect Storm Brings Health Care, Government and Business Together for a More Sustainable DC

There was a “perfect storm” of activity in the nation’s capital last week, and if you weren’t tuned in closely, you might have missed it.

The Sustainable DC pledge awaits formal signatures from health care representatives signifying their commitment.

The Sustainable DC pledge awaits formal signatures from health care representatives signifying their commitment.

This perfect storm was not another Superstorm Sandy. In fact, one might argue that one of the aims of this perfect storm was to build resilience to any such storms in the future. This perfect storm brought together representatives from 21 different health care organizations and local government officials at Kaiser Permanente’s Center for Total Health pledging to make the District of Columbia “the most sustainable city in the United States.

So what makes this newsworthy? The health care sector is certainly no stranger to coming together under the umbrella of sustainability. Over the past 20 years, the sector has been leading its very own “green revolution,” with hospitals and health care systems of all sizes looking hard at their contributions to environmental waste and pollution and what they must do to flip the equation and support more environmentally sustainable health care approaches.

What makes the Sustainable DC effort special is its focus on a single urban community, on bringing together leaders from health care, government and business sectors in a particular place, concentrating their efforts across governance, jobs and the economy, equity and diversity with the goal that, “By 2032, the District will be the healthiest, greenest, most livable city in the nation by using sustainability solutions to address core challenges.” The Sustainable DC plan outlines specific goals, targets and actions to get there. And the plan makes it clear that health care organizations to be at the table to bring the mighty vision to fruition.

Hospitals in America contribute an estimated 8 percent of greenhouse gas emissions, generate more than 2 million tons of waste each year and draw upon natural resources like water in ways that often counteract efforts to support the health of individuals and communities. Recognizing this paradox, many health care leaders have joined efforts like the Healthier Hospitals Initiative, Practice Greenhealth and Health Care Without Harm to green their own health care systems.

Kathy Gerwig, chief environmental stewardship officer for Kaiser Permanente, chronicles this green movement in her recent book, Greening Health Care: How Hospitals Can Heal the Planet. In the book, she notes the reasoning behind why health care organizations would move to join forces with each other and government to move the needle on environmental health:

“In the final analysis, most health systems engage with their communities not because they are incented to do so by federal and state tax law, but because they are mission-driven organizations that care deeply about the health of their communities. They know that individuals’ health depends on the health of the communities in which they live, work, learn, and play, and that the health of those communities depends on a healthy environment—health-sustaining air, water, soil, and all natural resources. They strongly believe, on the basis of compelling evidence, that when they invest their dollars and their expertise in promoting healthy social and physical environments, they are benefiting their communities and contributing to the health of everyone.”

That mission-driven energy was palpable on October 23, 2014. The energy in the room was exciting, collegial and activated. There was much talk of the sustainability progress that is already converging in DC – from an extensive array of green roofs and LEED-certified buildings across DC to the build out of the Metropolitan Trail to provide safe, physical activity and active transportation options. And there was a clear conviction expressed by health care leaders who were gathered, as well as the Mayor’s office, that this coming together for a more sustainable DC was just setting the stage for a convergence of efforts that would echo progress even beyond DC limits.

We can only hope that, as DC leads the way in sustainability, so goes the rest of the country.

Representatives from DC area health care organizations gather with Mayor Vincent Gray at the Center for Total Health after the signing of the Sustainable DC pledge.

Representatives from DC area health care organizations gather with Mayor Vincent Gray at the Center for Total Health after the signing of the Sustainable DC pledge.

Kaiser Permanente applauds the Sustainable DC plan, and we are pleased to be among the pledge-signers and the hosts for this momentous step forward. We have pledged our support and look forward to working with fellow health care system leaders to advance the goals outlined in the plan.

Kaiser Permanente physician director for the Center for Total Health, Ted Eytan, along with Keith Montgomery, executive director for the Center, nicely set the stage for the day’s event in their welcome remarks. Ted offered his follow-up reflections in a blog post that summarized the vision for total health that everyone in the room intuitively if not concretely echoed that morning. He writes, the Sustainable DC plan is “not just about the environment, it’s about everything that goes into creating an ‘equitable, prosperous, society.’”

Domestic Violence: A preventable public health problem

Domestic Violence InfographicThis month and every October, we pause to reflect on the profound impact that domestic violence has at the individual, community and national levels. It is well documented that one in four American women and one in fourteen men will be subject to domestic violence during their lifetime. We know more today than ever before about the science behind domestic violence — meaning its short-term and long-term health impacts.

Kaiser Permanente has a long track record of raising awareness and taking action on this topic for the benefit of the many lives it insures (many of whom are employees of the company). Its efforts were recognized last month by Peace Over Violence (a Los Angeles based non-profit whose goal it is to eliminate violence against women, youth and children) in the form of a corporate humanitarian award. This honor came about because of Kaiser Permanente’s leadership in partnering with the NO MORE campaign to raise public awareness about this issue via funding for programs serving survivors.

This week, the Institute for Health Policy website published an updated version of the article I authored in 2012 that highlights Kaiser Permanente initiatives and the gains over the last decade. A shining example is the implementation of an innovative approach for domestic violence prevention that was first piloted and launched in Kaiser Permanente’s Northern California region. In the words of Brigid McCaw, MD, director of that region’s family violence prevention program: “Transforming the health care response to domestic violence requires going beyond the traditional focus on didactic training for clinicians. Kaiser Permanente’s successful ‘systems model’ approach demonstrates that domestic violence prevention can be effectively incorporated into everyday health care services.”

You can read the story in its entirety at the Institute for Health Policy site.

Leadership Perspectives: Good Health Starts Where You Are

Editor’s Note: Today, we launch a recurring feature on the Center for Total Health Blog. “Leadership Perspectives” is a collection of guest blog posts from Kaiser Permanente leaders all about why we need to take a Total Health approach.

Today’s guest author is Elisa Mendel, national vice president of HealthWorks & Product Innovation for Kaiser Permanente, who shares her thoughts on place-based health.


 

How much time would you guess you spend at work each year? Would you be surprised if I said it’s something like 2,000 hours?

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Compare that to the time we spend with our doctor — maybe 15 minutes once or twice a year? That’s why place-based health is so important. At its core, good health starts with us — where we live, work, learn, and play.

That’s one of the reasons Kaiser Permanente partnered with leading national organizations to launch Thriving Schools. The idea is that schools are the hub of every community. Our work in schools focuses on four key areas: healthy eating, active living, school employee wellness, and a positive school environment. One of the active living programs is called Fire Up Your Feet. Fire Up Your Feet’s fall campaign launches October 1, and it encourages kids to walk to school with their parents, giving them much-needed exercise and some quality time together.

Another initiative I really love combines the childhood enthusiasm for play with the workplace. It’s called “Instant Recess.” A manager or wellness champion schedules time with their team —usually about 10 minutes. Everyone stops what they’re doing, and one of the team members leads the group in dancing and exercise. People are moving, getting their blood pumping, and laughing together. It’s had amazing results, because when you’re doing the chicken dance with your supervisor, suddenly things feel a little less stressful.

Kaiser Permanente piloted this in various work settings — call centers, IT, and even the ICU. One of the ICU patients heard the staff doing this Instant Recess every day on the floor and she was determined to get out of bed so she could be wheeled out to participate in the fun.

There’s no limit to the benefits of healthy living. It can lift spirits and deliver real business results. One study in the Journal of Occupational and Environmental Medicine showed that employees who ate healthy and exercised regularly were up to 27 percent less likely to be absent from work for health reasons.

Good health is becoming a national movement. Find your “healthy,” and start to share good health close to your home.

Exercise is the New Vital Sign!

Since the dawn of the doctor’s visit, taking vital signs has been a mainstay. Height, weight, temperature, heart rate, blood pressure. It’s a routine process that we participate in almost without thinking.

But at Kaiser Permanente, after the blood pressure cuff comes off, you’ll get questions that might surprise you: how many days a week do you exercise moderately or strenuously? How many minutes a day do you exercise at this level?

Come again? At first thought, asking about physical activity levels might seem unorthodox. Unlike other vital signs, it’s measuring a behavior, not a body part. But conventional thinking about health and health care has changed, and systems like Kaiser Permanente recognize that addressing personal behavior and lifestyle is just as important as addressing biology.

A new KP Policy Story from Benjamin Wheatley of the Kaiser Permanente Institute for Health Policy highlights our “Exercise as a Vital Sign” (EVS) initiative. Since 2009, Kaiser Permanente providers have asked patients about their exercise habits during routine office visits. Taking this “vital sign” encourages ongoing conversations between patients and providers about physical activity, and serves as a gateway for referring patients to activities such as yoga, Zumba classes or hiking clubs. Recent research shows positive results of the EVS initiative: in 2013, we found that asking about exercise habits is associated with modest weight loss in overweight patients and improved glucose control among diabetics.

You can read the story in its entirety at the Institute for Health Policy site.

The Best Community Spaces come from the Community

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Editor’s Note:  We have invited Scott Kratz, director of 11th Street Bridge Park to share with us some of his experiences as he takes this vision of a shared community space that supports health from concept to reality.  This is his second post with us. You can see his first post here.

Walking in a city park, have you ever experienced that frustrating moment? Maybe there’s no place to sit down. Or no shelter from the sun. Or there’s no family-friendly restroom in sight. The best civic spaces respond to the needs and desires of the community, but too often residents are left out of the design process. At the 11th Street Bridge Park, we’re working to change that with our new civic space in nation’s capital.

Together with the Washington, D.C. city government and a local non-profit organization “Building Bridges Across the River at THEARC” we’re transforming an aged-out freeway into a new park over the Anacostia River. After an extensive community outreach effort with more than 350 community meetings to date, we have created an amazing list of ideas for our park that were incorporated into a nation-wide design competition.

A primary goal of the 11th Street Bridge Park is to improve public health with this iconic new space. It will offer a safe place to play in a neighborhood that has the highest rates of obesity, and will incorporate healthy edible landscapes that can serve as a backdrop for farmers markets and planting/ harvest festivals for residents that have the lowest access to fresh fruits and vegetables in the region.

The design competition jury shortlisted four teams earlier this year, made up of the best landscape architects, architects and structural engineers in the country. After working all summer and meeting repeatedly with community stakeholders, the four teams submitted their renderings last week.

Now we want to hear from you. After reviewing the concepts here, tell us what you think! Take a short survey evaluating how each design meets our four key project goals. The results will be shared with our competition jury as it makes the final selection. We’ll announce the selected team on October 16. Stay tuned!

Six Burning Questions Health Care Leaders Have about ACOs

ACO imageIf you ask health care leaders what they think about Accountable Care Organizations (ACOs), you won’t be short on answers, writes Samantha DuPont of the Kaiser Permanente Institute for Health Policy, in a recent article and video on the Institute website.

According to the Centers for Medicare and Medicaid Services, ACOs are formed by groups of doctors, hospitals, and other health care providers, coming together to provide coordinated high quality care to their patients.

Early ACOs have had mixed success, and in light of emerging research questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

DuPont chronicles the six themes that emerged from the Institute’s work in asking leaders from across the nation their burning questions about ACOs:

1. What do ACOs look like today?

2. What factors will lead to ACO success?

2. Are current financial incentives strong enough to change provider behavior?

4. Will ACOs integrate with other types of caregivers?

5. Will ACOs successfully engage their patients?

6. What metrics will effectively measure quality?

How Innovation brought Exercise as a Vital Sign to Life

Two years ago, a team from Kaiser Permanente’s Innovation Consultancy was given the task of transforming patient data on exercise into actionable information that health care providers could use to encourage healthy behaviors. They called this initiative Project Move.

In part five of her seven-part blog series on Exercise as a Vital Sign (EVS), Dr. Latifat Apatira describes how the Innovation team went about the work of better understanding patients’ barriers and motivations regarding exercise.

The Innovators traveled to several Kaiser Permanente regions to analyze interactions between health care providers and members. They learned that patients are less active because of busy lifestyles. As for health providers, it was determined that they did not have time nor established resources to address their inactivity.

The group came up with several ideas to make EVS more actionable that are outlined in detail in the EVS blog, including screening questions from medical assistants and licensed vocational nurses that get entered into the medical record and passed along to the next level of care. Depending on how members answer the first round of questions, follow-up questions can lead to exercise prompts or referrals to health and wellness coaches.

While the results of the work are still being analyzed, new innovations are underway, including a website that helps members find resources for physical activity.

Using New Technology and Innovation to Improve Care

robotRoving about the hospital on wheels, the InTouch Health® RP-VITA® robot lets doctors see and talk with patients, families, and staff in the intensive care unit in the middle of the night. From their home computers, doctors guide the robot, connect via secure video, and virtually respond to urgent needs in a matter of minutes.

The Kaiser Permanente Institute for Health Policy’s latest Policy Story shows how a three-month pilot of InTouch® helped physicians improve communications and respond to after-hours emergencies at a Kaiser Permanente hospital in Fremont, CA. Champions of this new technology are attempting to spread its use across the organization.

This exciting development is just one innovation being tested at Kaiser Permanente, where an extensive support system enables physicians and front-line staff to bring new ideas to life.

The Story also suggests ways to overcome innovation road blocks in health care when trying to get ideas moving. Here’s one of the tips:  Share best practices to generate enthusiasm through blogging, email updates, and demonstrations.

We’re following our own advice with this blog thanks to the Center for Total Health. Please pass it on.

Helping patients ‘Find Their Thing’ is key to Exercise as a Vital Sign

Latifat T. Apatira, MD, MPH, fourth-year internal medicine and preventive medicine resident, believes that in order for Exercise as a Vital Sign (EVS) to succeed, health care providers need to help connect patients with resources in the communities where they live – outside of the exam room.

Part four of her seven-part blog highlights the community-clinic component of EVS, in which health care providers point their patients to a wealth of diverse programs and initiatives for fitness – what Dr. Apatira calls “finding their thing.”

The blog features several examples of community-clinic integration that Kaiser Permanente is exploring, as well as Dr. Apatira’s ideas of how to link patients to community resources.

Resources include:

  • City/Community Listings – Most official city websites have listings for activities that support physical activity.
  •  Parks Prescription – A movement to strengthen connections between the health care system and United States public lands, Park Prescription works with providers to encourage patients to get physically active at their local public parks.

Read the full blog to see more of Dr. Apatira’s health and fitness tips, including apps that track exercise levels.

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