Blog & Bloggers

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.

Weighing in on the Impact of Obesity Interventions

Measuring obesity in an individual person is relatively simple: get out the tape measure, step on the scale, calculate body mass index.

Measuring the impact of interventions that aim to reduce rates of obesity? Not so easy.

For all the attention directed toward combating the obesity epidemic in the United States, policymakers, researchers, advocates, and public health practitioners struggle to develop and agree upon measures that indicate whether a particular intervention is working, and even more, whether it is scalable and generalizable.

Compounding this issue is that different stakeholders have different evidence needs. Some are not convinced that an intervention is working unless they see rigorous data collected from a randomized controlled trial – considered to be the “gold standard.” Others may set the bar lower, knowing that we may never get perfect evidence, because obesity prevention involves a complex web of social, economic, environmental and behavioral factors.

These were some of the issues raised in a session at AcademyHealth’s 2014 National Health Policy Conference titled, “Obesity Prevention: How Much Evidence Do We Need to Act?”

In this session, a diverse set of stakeholders – Jeff Levi, Executive Director, Trust for America’s Health; Bill Hoagland, Senior Vice President, Bipartisan Policy Center; Linda Belheimer, Assistant Director of Health and Human Resources, Congressional Budget Office; and Shiriki Kumanyika, Professor, University of Pennsylvania Perelman School of Medicine –– discussed the myriad of issues surrounding obesity prevention measurement, and offered some clear steps for moving forward.

“There was strong agreement that the obesity epidemic is real and that we need to be thinking about how to address it,” said panel moderator Murray Ross, vice president, Kaiser Permanente, and director, Institute for Health Policy. “”It will have–and is already having–major implications for Americans’ health and America’s health care spending.”

In this short clip, Ross gives us the highlights of this important and timely conversation.

Note: Panelist Linda Bilheimer’s comments are not included in this video, but you can view her full presentation slides online.

Secretary Hunt with NHS and Kaiser Permanante delegations

NHS and Secretary of State for Health, Jeremy Hunt, Visit the CTH

Representatives from the National Health Service of England, along with British Secretary of State for Health, Jeremy Hunt, paid a visit to the Kaiser Permanente Center for Total Health on June 2. This marks the second visit to Kaiser Permanente for the Secretary.

This time, he spent a half-day contemplating many issues in health care which we all acknowledge are global in nature. Representatives from Kaiser Permanente shared the health care organization’s deep knowledge and experience regarding topics such as management of complex patients with chronic disease, leveraging technology to augment care, and physician management.  The exchange was interactive and lively.

Taking part in the discussion from Kaiser Permanente were Kim Horn, president of the Mid-Atlantic States region; Bernadette Loftus, MD, associate executive director of The Permanente Medical Group; Philip Fasano, executive vice president and chief information officer; Murray Ross, vice president and director of the Institute for Health Policy;  Ted Eytan, MD, physician director for the Center for Total Health;  and Walter Suarez, MD, executive director of health IT policy and strategy.

Phil Fasano, CTO of Kaiser Permanante, leads discussion.

Philip Fasano, executive vice president and CIO of Kaiser Permanente, leads discussion.

We all agreed that we work for the patients and our decisions should be guided by that core belief. For our British colleagues, the afternoon session triggered new ways of thinking about and approaching the challenges faced “back home.”

Kaiser Permanente is committed to helping shape the future of health care globally. Sessions like this one and other international learning forums are coordinated by Kaiser Permanente International (KPI).

Connecting Health With Place

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 often write pieces on the Center for Total Health blog about how important our surroundings can be to our health.  We’ve covered passionate discussions around built environments, and we’ve highlighted success stories.  What we haven’t been able to capture so far is the process.  We have invited Scott Kratz, director of 11th Street Bridge Park – a newly launched project – 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 first post with us.

Can your zip code determine your health? Epidemiologists tell us that place – where we live and work – is one of the greatest factors in health outcomes. Urban planning decisions afect people’s health. We know there is a strong link between regular physical activity and lowered risk of obesity and chronic diseases. But what if there is no safe place to play? What if one’s home is located in a food desert, as it has been for many residents in Washington, DC, without access to healthy meal choices?

Linking place and health is a key goal of the 11th Street Bridge Park – an innovative project in the nation’s capital to transform an old freeway bridge into a new civic space. As the 11th Street bridges across the Anacostia River have reached the end of their lifespan, the DC Office of Planning and a local non-profit, Building Bridges Across the River, will use part of the remaining infrastructure to build the 11th Street Bridge Park, a new park above the river.

We have led an extensive public outreach campaign asking local residents for their programming suggestions and have received many inspired ideas and wonderful support. The community has suggested innovative play spaces, urban agriculture, an environmental education center and kayak / canoe launches on the river below.

Community outreach continues with a brainstorming session on Tuesday, March 25 at Kaiser Permanente’s Center for Total Health with presentations by 11th Street Bridge Park’s team. All of these ideas will inform a nationwide design competition launched in March to imagine the new park.

But we need to be more than aspirational. We need results. To understand the ways that access to green space, farmers markets, planting festivals and kayak launches may improve health outcomes, we are implementing a Health Impact Assessment. This baseline data of residential health will enable a comparative analysis after the 11th Street Bridge Park opens in 2017/2018. If we’re successful, we can make a solid link between health and place — and build a bridge to a healthier Washington, DC.

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