Blog & Bloggers

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.

What is a ‘wired’ hospital — and what does it mean for patients?

Today’s post is authored by guest blogger Samantha DuPont, with the Kaiser Permanente Institute for Health Policy.

For the second year in a row, Kaiser Permanente’s California hospitals have been named “Health Care’s Most Wired” by Hospitals & Health Networks magazine. The honor recognizes our excellence in technology integration across the health care spectrum — infrastructure, procurement, human resources, security, clinical quality and safety, patient access, care continuum and health information exchange.

Kaiser Permanente has long been recognized as a leader in using technology to deliver high quality care. By 1970, we had implemented an electronic health record (EHR) for over 1 million patients. Today, our EHR, Kaiser Permanente HealthConnect®, connects 9.3 million members to their providers, and is one of the most advanced in the nation. By integrating comprehensive patient data, best practice research, treatment recommendations and other provider tools in one record, KP HealthConnect® ensures that patients receive the best care at every encounter.

We were also an early adopter of online health services for patients, as chronicled in an informative Kaiser Permanente Institute for Health Policy Story. In 1996 we began offering online prescription refills and appointment scheduling. Since then, our patient portal, My Health Manager, has grown a bevy of features, allowing patients to:

• view personal health information, including lab results, immunizations, past office visits,
• prescriptions, allergies, and health conditions;
• view, schedule, or cancel appointments;
• refill prescriptions;
• securely email doctors, pharmacists, and member services staff;
• take health assessments and programs that support healthy lifestyle changes and find information about health topics; and,
• manage health benefits, including viewing drug formularies and estimating the cost of treatments.

As of 2014, more than 4.4 million members are registered for My Health Manager on kp.org, nearly double the number in 2008. To learn more about how we’ve achieved success in getting patients online – and how that has improved health outcomes – read, “Engaging Patients Online with My Health Manager.”

Informing the Next Generation of Accountable Care Organizations

Some of the biggest buzz in health reform lies in the potential that Accountable Care Organizations (ACOs) have to help to reduce costs, improve care, and move away from fee-for-service to population-based payment.   But questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

Joy Lewis, MSW, MPH, of the Kaiser Permanente Institute for Health Policy, attended a July 13th convening in Washington D.C., hosted by the National Health Policy Forum, that highlighted some of the successes and challenges of early ACOs.

Kaiser Permanente has been supportive of this movement since the concept was first introduced in 2009.  While not technically an ACO, many elements of our care system – such as use of electronic health records, team-based care, and population management tools – ideally will be a part of ACOs.

Read the Kaiser Permanente Institute for Health Policy Observation describing Lewis’ highlights of the meeting, which include tactics for improving quality, increasing savings and overcoming the fee-for-service chassis.

More on Community Access to Healthy Foods with Elevation DC

On Tuesday, June 24, an panel came together for a discussion about food in our neighborhoods – where it comes from, what barriers keep healthy foods from some communities, and solutions that are working. Kaiser Permanente and Elevation DC hosted the discussion right here at the Center for Total Health.

Food writer Mary Beth Albright moderated a lively conversation among Laine Cidlowski, an urban sustainability planner for the D.C. Office of Planning; JuJu Harris, culinary educator with the Arcadia Center for Sustainable Food and Agriculture; and Ted Eytan, MD, physician director at the Center for Total Health. Panelists shared different perspectives about D.C.’s food system and considered the economics of good health.

This discussion was a prime opportunity to consider the consequences as well as the opportunities related to food in neighborhoods. According to Cidlowski, communities of high poverty that are more than a 10-minute walk or one bus transfer away from a full-service grocery store are considered food deserts. D.C. liquor stores and fast food restaurants dominate some of the most vulnerable communities where grocery stores have gone out of business or have never existed. This condition leaves residents wanting – and to a large extent, vulnerable to chronic illness and low quality of life.

Organizations such as Arcadia farms, with its mobile market, are filling the gap by bringing fresh produce to people where they live and teaching residents about food selection and meal preparation. Harris, Arcadia’s culinary educator and SNAP outreach coordinator, hosts cooking demonstrations at the markets to help engage customers about what to do with the produce once they get home. She shared that even a 10-minute walk can sometimes be too much for people living in poverty.

Community gardens, gardening plots and urban farms are also part of the solution, however Cidlowski shared that with so much demand, there are now wait lists – some as long as three years – to use some green spaces. But with revitalization efforts in the city, much consideration is being given to food access in the District.

Eytan offered the physician perspective. He highlighted the connection between food and health and why this issue is integral to Kaiser Permanente’s total health mission. “We want to provide health care, not just sick care,” said Eytan, who encourages patients to make time for physical activity and healthy meal preparation, but acknowledges that healthy choices are difficult to make in many neighborhoods.

Enjoy more food for thought—read Elevation DC’s full story.

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