Mom and Dad? We Need to Talk.

While watching our parents grow older is tough, the hardest part of it for most of us is the role reversal that takes place.  Suddenly sons and daughters are taking care of moms and dads — and that can often start with tough conversations on awkward subjects.  How do you talk with Mom about when it’s time to stop driving?  When Dad re-enters the dating world, what’s the best way to broach the topic of safe sex?  This episode of Total Health Radio is all about these difficult — but necessary — conversations we need to have with our aging parents.

A Healthy Beginning for Babies and Their Moms

CEX12d041Last week’s annual “Building a Healthier Future” Summit put on by the Partnership for a Healthier America provided an opportunity to highlight what many organizations across the country are doing to address the underlying causes of childhood obesity.

For Kaiser Permanente, that meant not only a chance to show that we could and did deliver on our commitment to the highest levels of exclusive breastfeeding within our hospitals, but also the opportunity to showcase how Kaiser Permanente is building upon those successes by rolling out a comprehensive “Healthy Beginnings” effort to address the health of mother and child throughout the first years of life.

Robert Riewerts, MD, regional chief of pediatrics for Southern California Permanente Medical Group and clinical lead for childhood obesity for Kaiser Permanente presented an overview of the Healthy Beginnings work at a breakout session at the Summit. We had the opportunity to interview Dr. Riewerts alongside Jocelyn Audelo, RN, senior consultant at Kaiser Permanente’s Care Management Institute who coordinates Kaiser Permanente’s interregional work around Healthy Beginnings.

CTH Blog: Why is Kaiser Permanente focused on supporting a program of “Healthy Beginnings?”

Dr. Robert Riewerts: As an integrated health care system, Kaiser Permanente has been very interested in providing the best support we can to breastfeeding mothers. In our system, we deliver nearly 90,000 babies each year, so we have an incredible opportunity to make an impact on the lives of those babies.

Childhood obesity is a serious problem in America, and we’ve learned from research and from the care of our own patients, that if we support breastfeeding effectively, we’re going to produce a population of children that start out healthy. With effective breastfeeding support, those babies will get the important nutrients they need as young babies and they’ll be more likely to be healthy children later on.

Jocelyn Audelo, RN: Pregnancy is also a critical time in the development of healthy habits. As a new family is coming into being, we have the opportunity as a health care system to help support some of the habits – like breastfeeding, healthy diet patterns, and plenty of movement – that can translate to a pattern of well being over time for a family.

CTH: What can you tell us about the recent research showing trends in obesity reduction in children age 2 – 5?

RR: There’s been a lot of excitement around the recent article in the in the Journal of the American Medical Association that showed a 43% reduction in obesity in early childhood, ages 2 – 5, range. This research gives us hope that the work that we’re doing is effectively reducing the rate of childhood obesity. One of the factors quoted in the article is the fact that early breastfeeding and the support of breastfeeding may be an effective reason why we are seeing this reduction in obesity.

Although we are hopeful that this is a trend for the future, we still have a whole lot of work to do. And Kaiser Permanente’s relationship with the Partnership for a Healthier America and our commitment to the Partnership represents a road that we will be staying the course on, in order to make greater progress in addressing childhood obesity.

CTH: What would a comprehensive Healthy Beginnings program look like?

JA: At Kaiser Permanente, we feel that there is an opportunity to broaden our approach beyond just breastfeeding in support of a healthy weight trajectory throughout life, that really has its beginning in the pregnancy and early childhood time frame. Healthy Beginnings is our Kaiser Permanente approach to support healthy weight, active living and good nutrition from the time before a woman becomes pregnant, throughout her pregnancy and throughout the early life of the child. Examples might include things like helping women to get healthy and fit before conceiving, supporting women and families in emotional and behavioral health, helping pregnant women to stop using tobacco and other harmful substances, and teaching how families can incorporate a pattern of healthy foods – with plenty of vegetables and fruits – for babies and young children.

RR: Kaiser Permanente has a wealth of employees involved in all sectors of health care. We want all of our physicians, our nursing staff, our doctors who are delivering babies and caring for mothers during pregnancy to be aware of the importance of breastfeeding and to really start that infant out on a good healthy lifestyle.

JA: We know there are lots of things that we can do clinically to support a healthy beginning, but we know it needs to be much bigger than that. It needs to involve our community partners, our built environment to support physical activity and good nutrition, and numerous areas that we need to continually develop capacity in.

Since we know that what happens during pregnancy and the early childhood timeframe is critically important for a life course of Total Health, we’re focusing intensely on this Healthy Beginnings work. We are very excited about the journey we’re on, to support women and children and their families on a trajectory of Total Health from the beginning.

Spreading Health: Reducing heart attacks and strokes with those at highest risk.

What if there were a simple treatment that was proven to prevent heart attacks and strokes in people with diabetes?

In truth, this isn’t a “what if” scenario.  This exists right now.

In fact, Kaiser Permanente is furthering its reach to low-income populations with this simple treatment that has been preventing thousands of heart attacks and strokes in diabetic patients.

The organization released a video (posted above) to 55 community clinics across the country to help patients understand the significance of a treatment that could save their lives. The video (also available in Spanish) explains about a program – called “ALL/PHASE” – that includes the use of three low-cost medications to reduce heart attacks and strokes.

Since 2007, more than 60 of Kaiser Permanente’s community partners in California, the Northwest, Mid-Atlantic States and Colorado have implemented ALL/PHASE, improving the health of nearly 100,000 low-income diabetic patients.

To learn more about the benefits of the program and community outreach, we reached out to Kaiser Permanente’s Jim Dudl, MD, diabetes clinical lead, Care Management Institute, and Winston Wong, MD, medical director and community benefit director, Disparities Improvement and Quality Initiatives.

How did Kaiser Permanente’s ALL/PHASE program come about?

Dr. Dudl: “The ALL (Aspirin, Lisinopril, and a lipid-lowering medication) initiative was developed by Kaiser Permanente in 2003 to reduce cardiovascular disease among our diabetic patients over age 50 by prescribing the ALL triad of medications. It was critical to us because heart disease and stroke was – and still is – the leading cause of death and disability in the United States and the world. People with diabetes are two to four times more likely to have a heart attack or stroke and 65 percent of those will die from one of those events. But it can be prevented with this very simple and cost effective treatment.

There have a few regional variations to the program over the years to include the promotion of healthy lifestyle changes. Northern California added PHASE (which stands for Preventing Heart Attacks and Strokes Everyday). In Southern California, we have ALL HEART (Heart Smart Diet, Exercise, Alcohol Limits, Rx Medicine Compliance, and Tobacco Cessation Aspirin Lisinopril and Lipid lowering). Whether it’s ALL/PHASE or ALL HEART, the central component is the same, which is the use of the three medications.

What benefits did this program have on Kaiser Permanente members?

Dr. Dudl:  We found that over a three year period, 70,000  Kaiser Permanente members who took both the Lisinopril and the lipid lowering pills lowered their incidence of heart attacks and strokes by more than 60%. The evaluation also proved that if administered to the entire Kaiser Permanente diabetic population, ALL/PHASE would prevent more than 8,000 hospitalizations for heart attacks and strokes each year.

Based on this great success, we knew we wanted to share ALL/PHASE more broadly.

Why did you reach out to community clinics specifically?

Dr. Wong:  Kaiser Permanente is committed to its partnerships with the institutions that serve on the front lines of health care for the uninsured and underserved. These relationships are critical to fulfilling our mission, which is to provide affordable, high quality healthcare services to improve the health of our members and the communities we serve. We do this by investing in quality improvement and population health and support efforts which will transform care and improve health care access for our most vulnerable populations. Sharing our ALL/PHASE initiative is a perfect example of how we can do that. Read More

Mingle and Move with the Partnership for a Healthier America

Every March, the Partnership for a Healthier America gathers leaders of the effort to end childhood obesity for a summit in Washington, DC. Kaiser Permanante is grateful to once again host the welcome reception at the Center for Total Health on behalf of the founding partners of PHA: Alliance for a Healthier Generation, The California Endowment, Kaiser Permanente, Nemours, Robert Wood Johnson Foundation and W.K. Kellogg Foundation.

James R. Gavin III, board chair for Partnership for a Healthier America, speaks at the reception held at the Center for Total Health.

James R. Gavin III, board chair for Partnership for a Healthier America, speaks at the reception held at the Center for Total Health.


Sam Kass, executive director of Let's Move! and senior policy advisor for nutrition policy for The White House.

Sam Kass, executive director of Let’s Move! and senior policy advisor for nutrition policy for The White House.


The menu at the reception included a variety of healthy options...

The menu at the reception included a variety of healthy options…


…including a build-your-own-salad bar.

…including a build-your-own-salad bar.

For tips to help your kids and community, check out Kaiser Permanente’s thriving schools campaign and the PHA resources page.

IHI Summit Excursion to the Center for Total Health

IHI Summit attendees visit the Center for Total Health, hosted by Dr. Ed Ellison.

IHI Summit attendees visit the Center for Total Health, hosted by Dr. Ed Ellison.

Today, the Center for Total Health hosted an excursion for attendees of the 15th annual Institute for Healthcare Improvement (IHI) International Summit on Improving Patient Care. Ed Ellison, MD, executive director of the Southern California Permanente Medical Group, was joined by IHI Fellow and Kaiser Permanente  member Gilbert Salinas, BS, MPA, for a vibrant discussion on improving care through patient engagement and feedback.

Dr. Ed Ellison and Gilbert Salinas, BS, MPA

Ed Ellison, MD, and Gilbert Salinas, BS, MPA

Thanks to all who attended, with special thanks to Dr. Ellison and Gilbert for leading the conversation.


Photo of the Week: German IT Delegation

Today at the Center for Total Health, Kaiser Permanente International hosted a group of German Health IT delegates for an informational session. Joy Lewis, MPH provided an overview of Kaiser Permanente to set the context for the dialogue that followed. The group saw a KP HealthConnect demonstration and heard about being a physician Tom Tesoriero, MD, from the Mid-Atlantic Permanante Medical Group, followed by a discussion with Sandra Stuart, Executive Director of Health IT Standards. Sandra talked with the group about the future of HIT and shared some examples of how Kaiser Permanente is forward-thinking about the use of technology at four different care sites (hospital, clinic, home and virtual).

Dr. Tesoriero

Dr. Tesoriero



Group Discussion


Sandra Stuart speaks to the group about Kaiser Permanente's approach to Health IT

Sandra Stuart speaks to the group about Kaiser Permanente’s approach to Health IT


Connected Care is Better Care

Dr. Robert Pearl, CEO of The Permanente Medical Group (Photo courtesy Health Affairs)

Dr. Robert Pearl, CEO of The Permanente Medical Group, speaks at Health Affairs briefing on Feb. 4. (Photo courtesy Health Affairs)

“Connected care” is gaining more momentum in the health care industry.  Health care providers are adopting electronic health records with federal support and standard setting. Consumer electronics makers and applications developers are offering more tools and devices for consumers to track and manage their health.  Patients have more options for accessing care and information, and communicating with care teams.

On February 4 in Washington, DC, Dr. Robert Pearl, CEO of The Permanente Medical Group, shared Kaiser Permanente’s experience as a leader bringing electronic tools to its 3.4 million Northern California members in a discussion sponsored by the journal Health Affairs.   Here is Dr. Pearl’s article in the recent issue and a video recording of the event and slides.

Dr. Pearl shared his optimism that health care is poised to be transformed by electronic technology in ways similar to the retail, travel, and finance sectors. He also noted some barriers in the way, including a predominantly “fee-for-service” payment model that fails to incentivize non face-to-face care or investments in information systems geared to prevention and care coordination. “We can’t just lay technology on the current system,” Dr. Pearl noted. He cited new payment models such as ACOs, the growing popularity of Medicare Advantage and its “5 Stars” quality incentives, and hospital readmission penalties as all providing momentum for changing behavior of physicians and other parts of the health care system. Read More

Mindfulness, the Topic of the Moment — on Total Health Radio

You can’t turn on the TV or search the Web these days without coming across someone talking about mindfulness. Time Magazine even made it this week’s cover story. But what is it, really? For a quick tutorial on what everyone is talking about — and why you may want to try it yourself — listen to this episode of Total Health Radio.

Exclusive bonus clips, as well as other resources and links to information on the topic, are available on Total Health Radio’s official website.

Childhood Vaccinations — Myths and Realities: Total Health Radio

As a parent, there is nothing we feel so strongly as the need to keep our children safe — and not knowing how to best do that can be challenging.  On the topic of childhood vaccinations, there are countless articles to be found on the Web, and for every recommendation for a certain vaccine, there also seems to be a warning.  This episode of Total Health Radio explores the myths and realities of childhood vaccines and presents what should be considered as you make your decision on vaccinating your kids.

The Buzz at Davos: A Digital Health Revolution

Today, the World Economic Forum blog published a post by Jamie Ferguson, vice president of health IT for Kaiser Permanente:  A Digital Health Revolution in the Making.

“Mobile apps and wearable devices empower individuals to manage their health and wellness,” Ferguson says in his blog post.  “Big data analytics harness individual information for public health, safety and research, while remote monitoring devices, telemedicine, electronic health records and interoperability enable the right care, anywhere. All of this technology and data ultimately result in low-cost wellness and high-value healthcare.”

These things can all have great impact, but Ferguson points out that we can and should do more to really leverage the digital health revolution currently underway.  To that end, the WEF will be tapping the expertise of more than 1,000 health care decision makers and policy leaders to create a Digital Health Knowledge Exchange toolkit – a knowledge commons to share best practices.

The WEF’s Global Agenda Council on Digital Health is calling for much more – all of it focused on taking full advantage of all of the developments in digital health and its impact on world societies and economies as well as the health and wellness of individuals.

Read all of Ferguson’s blog post here.

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