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?

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.

Advice for New Moms’ First Hours, Days and Weeks Following Childbirth

After the BirthTotal Health Radio has had straight talk about pregnancy and truth telling about childbirth.  But what about those first days and weeks after giving birth?  In this episode, we focus less on the baby and more on the changes you are going through during that time – what’s normal, what’s not, and what may surprise you.  Packed with tips for making new moms more comfortable and advice on how spouses and partners can best provide support, this show is valuable listening for expectant parents – and the people who love them.

For more information on this episode and for links to additional resources every new mom should have at her fingertips, check out the Total Health Radio website.

Walking the Talk: Despite Challenges of Implementation, Exercise as a Vital Sign Initiative is Thriving

EVS_Blog2_doc_patientIt is well known that 30 minutes of moderate physical activity, five days a week, can over the long haul minimize the effects of many chronic diseases. Kaiser Permanente has made it a goal to ask all patients their exercise information – How many minutes per day? How many days per week? – in an effort to help them become more active and therefore more healthy.

This initiative is called Exercise as a Vital Sign, and while it may seem simple for all medical assistants and primary care providers to ask their patients those two questions and record the data in the electronic health record, it is more complex than that. Even now, five years since the first members were being questioned, EVS continues to be a work in progress

Read Dr. Latifat Apatira’s article, the second of a seven-part series, about how enthusiasm for the project remains high, despite the challenges. Learn from experts why Exercise as a Vital Sign is at the heart of Kaiser Permanente’s Total Health strategic vision, where Total Health is defined as a state of physical, mental, and social well being.

Gluten and You

Have you made the change to gluten-free eating? If so, you are not alone. The topic seems to be everywhere these days. And yet amid all of the press coverage and chatter around gluten, recent surveys indicate that many people aren’t sure what gluten actually is.

To help people understand what it is as well as the effect it can have on some — but not all — people’s bodies, ABC News Chief Health/Medical Editor, Dr. Richard Besser, dedicated his Tweetchat last week entirely to gluten. Kaiser Permanente registered dietician Kimi McAdam, RD, was one of the experts available to answer questions during the chat. We’ve included highlights from the conversation in the Storify below.

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.

How Community-Clinic Integration is Boosting Population Health — Part 2

When community organizations collaborate, change happens. Earmarked as one of the next frontiers in public health, community-clinic integration strengthens the health of populations through inclusion, collaboration, and commitment.

Earlier this week, we brought you the first installment of a two-part interview between Kaiser Permanente leaders about the need for community-clinic integration. In this post, Holly Potter, vice president of Brand Communication for Kaiser Permanente, continues her conversation with Loel Solomon, vice president of Community Health for  and Jandel Allen-Davis, MD, vice president of Government and External Relations for Kaiser Permanente Colorado about the creation – and the successes – of community initiative-turned-nonprofit, LiveWell Colorado.

HP: In Colorado, LiveWell has been very successful. Can you talk about that work and what has been achieved?

Jandel: Our work with LiveWell Colorado often makes me think of that Margaret Mead quote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” This is a program that was started in Kaiser Permanente and in order to scale it, we invited other funders to work with us to take this program to the entire community. The Colorado Health Foundation and The Colorado Department of Public Health and Environment and Kaiser Permanente are the founding funders of the organization.

One essential element of LiveWell programming is that we work with a diverse group of community members to decide on approaches to address the issue of obesity through deployment of healthy eating and active living assets. The outcome of using community based assets to eliminate or reduce obesity is that the community is deeply invested in the results, and we build tremendous capacity in its members.

Loel: A relevant proverb in this case says, “If you want to go fast, go alone. If you want to go far, go together.” In Colorado, Kaiser Permanente wanted to do a place-based initiative. The Colorado Health Foundation wanted to do something similar, and we realized that by combining our forces, we could create much more impact. Now, LiveWell has gone from three communities to 23 communities, some of which have been doing this change work for nearly eight years.

There’s an infrastructure for technical assistance and evaluation that serve all these communities, and there are these state-level policy changes that we’ve been able to generate because all of these communities are creating the public will to have healthy school breakfasts, active transportation, and other things. It’s been powerful.

HP: When you spoke of lowering barriers to food assistance and now with the work with LiveWell, you are addressing policy and systems change that address health behaviors. Why is that so important?

Loel: Policy has a huge influence on the choices people have. It influences their opportunities, and the biggest way we can impact people’s health right now is to create a policy and environmental changes that help make the healthy choice the easy choice. Whether we’re talking about policies and practices about smoking in the workplace, or we’re talking about school lunches and access to PE, or people’s ability to access food stamps, the decisions that elected officials make and the private policies that organizations adopt have such a huge impact on health.

Jandel: We need to recognize that there are no silver bullets available to solve these deeply rooted health and social issues. Addressing these will require multi-pronged approaches. Simply providing food for those who are food insecure may not solve the long-term problem, which is the reason that people don’t have food in the first place. It’s a really interesting choreography of many actions that hopefully begin to affect change on a large scale.

HP: This is the Center for Total Health blog and I know Total Health is central to what drives each of you. How does the concept of Total Health influence your work?

Loel: The way I often think about Total Health is that it requires us to identify and act on the levers of health that exist both inside and outside the walls of Kaiser Permanente. We are focusing on not only what we do as a delivery system, but also what we can influence outside our clinic walls – where our members spend most of their time. To the extent that we can, we work with community partners to address violence and access to healthy food; leverage our workforce to volunteer in schools; and our clinicians to advocate for healthy school lunches. That’s seizing the levers of health. Doing that is necessary to improve the health of the populations we serve.

Jandel: Total Health embraces the notion that Kaiser Permanente plays many of the positions that are important in addressing health. In addition to the care delivery system, we influence many of the upstream inputs related to health and wellness that solve longer-term problems. It differentiates us. If we continue this work, I think we’re unstoppable.

HP: Thank you both for your time.

How Community-Clinic Integration is Boosting Population Health

Communities play a critical role in shaping Total Health. Too often, the ability to lead a healthy life is stymied by a person’s environment. A lack of access to healthy food, community violence, and pollution can lead to conditions like obesity, depression, or asthma.

Loel Solomon, Vice President of Community Health for Kaiser Permanente

Loel Solomon, Vice President of Community Health for Kaiser Permanente

Community-clinic integration is the next frontier in strengthening the health of populations. Holly Potter, vice president of Brand Communication for Kaiser Permanente, sat down with Loel Solomon, vice president of Community Health for Kaiser Permanente, and Jandel Allen-Davis, MD, vice president of Government and External Relations for Kaiser Permanente Colorado, to talk about what community-clinic integration is, and how it’s driving improvements in health. Today’s post is the first in a two-part series.

HP: Thank you both for making the time to talk with me. Let’s start with the basics. What is community health and how does it affect individual health outcomes?

Loel: There are two elements here. One is that community health is the health of a population, not just an individual. That means that you’re looking at those whose health is most challenged and lifting them up in order to increase the health of the whole community.

On another level, community health points a spotlight on community factors that influence behaviors – things like parks and walking trails, which can increase physical activity, or access to grocery stores and farmers’ markets, which can increase consumption of healthy food. There are other factors in neighborhoods that influence people’s health directly like pollution and environmental toxins. So community health invites us to think about both influencing the health of overall populations, as well as focusing on these things in the community environments that influence health.

Jandel Allen-Davis, MD, Vice President of Government and External Relations for Kaiser Permanente Colorado

Jandel Allen-Davis, MD, Vice President of Government and External Relations for Kaiser Permanente Colorado

Jandel: There are other contributors to health beyond our physical status. Community health also includes components of well-being such as our relationships, our community connectedness, our emotional state and our financial well-being.

HP: To address community health, you both speak of community-clinic integration. What is community-clinic integration and why does it matter?

Jandel: As a physician, I experienced 25 years of observing the impacts of social factors on health and how they play out in the exam room. I can speak to the frustration that I felt in knowing that social needs are not being met, and you don’t have the tools to deal with them. I’ve often thought over the years, “What this person needs cannot be found in a pill bottle or addressed with a scalpel.” I think that community-clinic integration has the potential for us to be thinking about, “How do we bring those resources not just to our patients, but to the providers who are doing their best every day to provide that level of care for people?” I think there’s real value for us to be able to help solve for that dilemma, which is hopefully going to improve cost, quality, and the care experience for patients.

Loel: It’s also what we do as an organization to systematically connect our members to the very rich set of assets and organizations that exist in their communities. Doing this at scale is a real challenge given how varied our members’ needs are, and how diverse the local resource landscape is. But it’s a real imperative for us to figure out how to do that, and there’s a lot of great work under way in our organization that will help us move forward.

HP: What does that really look like in practice?

Jandel: One example is our work with Hunger Free Colorado. When the recession hit, hunger became more evident among populations we typically didn’t think about. In 2011, we did a pilot program and screened our own members for food insecurity by asking the question, “When was the last time you worried whether your food would run out before you had the money to buy more?”

Of the population we screened, about 14 percent of those screened tested positive for food insecurity. These were people who had commercial health insurance, meaning they had jobs that provided health benefits. Given that, there were all sorts of assumptions about who they were and what resources they had. What we found is that if you don’t ask the right questions, this foundational need related to food access would go unnoticed. Today, under the leadership of Dr. Sandy Stenmark, we are screening all of our new obstetrical patients for food insecurity and are rolling the screening out in pediatrics.

Loel: Due to this assessment in the exam room, we were able to connect these members to community-based resources through Hunger Free Colorado. This organization helped them get food stamps (SNAP), it helped connect them to local food pantries, and with a whole variety of other resources.

Then there’s the policy change piece. Out of the 50 states, Colorado ranks at the bottom in terms of the percentage of the population eligible for food stamps who actually receives them. Through Hunger Free Colorado, we have been able to make changes in state and local policy to lessen the burden and lower the barrier for people to take advantage of food stamps.

Check in tomorrow for Part 2 of this interview.

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).

Count Me In: Tracking Days, Minutes of Activity Can Lead to More Active, Healthier Patients


Is your physician asking you how many minutes of physical activity you’re engaging in each day? Are you getting 150 minutes of exercise per week? Through a clinical initiative called Exercise as a Vital Sign (EVS), Kaiser Permanente is now collecting and recording the exercise information in its electronic medical record and helping patients become more active .

EVS is designed to systematically ascertain patient-reported exercise levels and encourage patients during outpatient visits to become more active. It is also designed to combat inactivity which is reported to be the cause of 6 percent of the cases of coronary artery disease, 7 percent of type 2 diabetes, 10 percent of breast cancer, and 10 percent of colon cancer.

In this seven-part series titled, “Exercise as a Vital Sign in Primary Care,” author Latifat T. Apatira, MD, MPH, — a fourth-year internal medicine and preventive medicine resident at Kaiser Permanente San Francisco Medical Center — sheds light on an important clinical strategy to address obesity and physical inactivity. Part I of the series discusses how Kaiser Permanente gets its patients moving with EVS. Check it out here.

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