Defining Success In Resolving Health-Related Social Needs

by

A recent Health Affairs blog offers a perspective on the challenges of addressing the social needs of patients – particularly when the health care system at large doesn’t have common language to describe what a successful intervention might look like. Programs such as Kaiser Permanente’s Total Health initiative and CMS’ Accountable Health Community model screen participants for unmet social needs, yet there is lack of clear definition as to how the community – or delivery system – should be accountable for resolving these needs. This will continue to be a complex area for exploration as health care increasingly moves outside of the exam room into the community, and as we continue to look at how factors such as where our patients live, work, play and pray impact their overall health.

Read the blog here

Sticking to our New Year Resolutions

by

The Center for Total Health team — and extended staff members — have kicked off a three-day clean eating challenge. We’ll be sampling local seasonal flavors and focusing on soups and juices as the core of our program.  Our goal is to reset our taste buds and to refocus our efforts on healthier eating.  Over the next three days we’ll search out fresh, local vegetables and juices along with select nuts and grains. Some might question our timing before the big football game this weekend, but there’s probably never a perfect time to start eating healthier.  It’s easy to worry about your work schedule, family and social gatherings as possible excuses for not watching your diet. We also know that  social support is a huge help, especially in the office setting. As colleagues who spend many hours working together, we can help reinforce healthier habits starting with all our food choices at work.

Juicing

As always the Center for Total Health supports healthier choices for meetings and events held here. We do not endorse any particular diet or meal vendors. Check with your health care provider if you have any questions or concerns about eating healthier. There are a number of resources available to assist you on kp.org.

Strengthening Medicaid as a Critical Lever in Building a Culture of Health

by

The National Academy of Social Insurance (NASI) hosted its annual membership meeting and reception at The Center for Total Health,  prior to its 29th Annual Policy Research Conference on January 26.

Joy Lewis, senior health policy leader of Kaiser Permanente’s Institute for Health Policy served on the panel that looked at Medicaid’s role as an insurer of more than 70 million people and its capacity to address the underlying social determinants of health.

“We approach today’s discussion with the belief that Medicaid will continue to serve a pivotal role as an insurer of low-income populations. More and more, health care leaders, providers, and others in the health care ecosystem are giving recognition to the fact that health is greatly influenced by complex social factors,” said Lewis.

The report, Strengthening Medicaid as a Critical Lever in Building a Culture of Health, is the result of a study panel that included state Medicaid program directors, public health and health policy experts, health researchers, medical and health professionals, and health plans, and was convened by the nonprofit NASI.

“The panel approached this project with several key goals in mind,” said Trish Riley, co-chair of the study panel and Executive Director at the National Academy of State Healthy Policy. “We aimed to discuss strategies that could increase Medicaid’s potential to help move the dial on individual and population health, while improving health care quality and program efficiency.”

To learn more about the report: https://www.nasi.org/sites/default/files/research/Strengthening_Medicaid_as_a_Critical_Lever_Low_Res.pdf

To read the entire press release about the conference and highlights of the repor:https://www.nasi.org/press/releases/2017/01/press-release-nonpartisan-expert-panel-recommends-steps

The National Academy of Social Insurance is a nonprofit, nonpartisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solution challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.

Pictured above keynote speaker: Ai-jen Poo, Director, National Domestic Workers Alliance (NDWA) and Co-director, Caring Across Generations

NBA and Kaiser Permanente to Host Second Annual Total Health Forum

by

The National Basketball Association and Kaiser Permanente, will hold the second annual Total Health Forum on Thursday, Jan. 26 in Los Angeles. Participants include NBA Commissioner Adam Silver, Kaiser Permanente Chairman and CEO Bernard J. Tyson, NBA All-Star Chris Paul, Hall of Famer Jerry West, NBA Legends Rick Fox and James Worthy, and two-time WNBA Champion Sue Bird.

Bringing together leaders across health, business, community and sports, the Total Health Forum will explore a variety of health and wellness issues affecting families across the country. Through interactive panel discussions and insightful Q&A’s, this year’s forum will address opportunities and strategies for achieving total health of mind, body and spirit, including strengthening both community and personal resiliency. Panelists also will include Oakland Mayor Libby Schaaf, Baltimore Mayor Catherine Pugh and Playworks founder Jill Vialet.nba-fit-week-250x179

NBA FIT Week presented by Kaiser Permanente will feature programs and events designed to inspire the NBA family to be active, eat healthy and play together, while teaching values of the game like hard work, discipline, leadership and teamwork. NBA FIT Team members will help encourage fans of all ages to participate through fitness events and social media.

Learn more here.

Honoring National Diabetes Month and World Diabetes Day

by

In honor of National Diabetes Month and World Diabetes Day, we wanted to highlight important research available at the Center for Total Health.  The study is one of the largest and most ethnically diverse to look at maternal diabetes as a risk factor for autism.  Many have probably heard of other suspected causes, but time and time again guests at the center are surprised to hear that children whose mothers developed gestational diabetes by the 26th week of pregnancy were at increased risk of developing autism later in life, according to a Kaiser Permanente study published in the Journal of the American Medical Association on April 14, 2015.  And that’s just a sample of the power of an electronic health record (EHR).

“Kaiser Permanente is uniquely qualified to conduct large scale studies in a real-word setting with the power of our integrated, comprehensive electronic health record,” said lead author Anny Xiang, of the Kaiser Permanente Southern California Department of Research and Evaluation.  “We can follow many women through the electronic health records and assess potential links between historical information and their own health outcomes, and their children’s health outcomes. The large size is particularly important to study rare diseases such as autism spectrum disorders. Appropriate analysis of these data can reveal important findings which could impact our approach to patient care.” She noted that this was an observational study, therefore the findings reveal associations between gestational diabetes and risk of a child developing autism rather than proving a cause and effect relationship.

Researchers examined the electronic health records of more than 322,000 ethnically diverse children born between 28 and 44 weeks at Kaiser Permanente Southern California medical centers between January 1995 and December 2009.  They followed the children for an average of 5.5 years and found that those exposed to gestational diabetes by the 26th week of pregnancy had a 63% increased risk of being diagnose with an autism spectrum disorder than children who were not exposed.  After taking into account maternal age, education, race and ethnicity, household income and other factors, the increased risk of autism associated with gestational diabetes was 42 percent.

For more information on the study, click here.

To learn more about this and other innovation at Kaiser Permanente, visit the Center for Total Health.

Fighting Hunger During the Holiday

by

We know that “total health” is about more than absence of sickness, it’s about having a safe place to live, food to eat and nurturing, supportive relationships among other things. The holidays are always a great time to do what we can for our communities to support their total health. At the Center for Total Health, one community partner we wanted to call out this upcoming holiday is DC Central Kitchen. We offer a guest post from DC Central Kitchen’s Alex Moore below. Alex is featured in our Farmers Market display where we talk about food as a strategy for designing healthier communities. Keep his thoughts in mind as you think about giving back to the community this holiday season.

Happy holidays,

Keith Montgomery

 

Fighting Hunger During the Holiday Season

Alex Moore, Chief Development Officer at DC Central Kitchen

The holiday season is a time for giving back and helping others. At DC Central Kitchen, for example, we fight hunger by providing meals for our community each day while making longer-term investments in career training and job creation that strengthen local food systems and reduce disparities in health and economic opportunity, but we can’t do it alone! Here are some fun ways that you can help us and other food resource programs reach our goals:

  • Organize a turkey drive with your co-workers – Turn it into a friendly competition by making teams to see who can collect and/or donate the most turkeys! This will help provide the ultimate Thanksgiving meal for those in need.
  • Help plan a food drive through in your neighborhood or apartment building – By collecting staples such as beans, brown rice and canned goods, you can really food resource programs prepare daily meals on a large-scale.
  • Register to volunteer – Volunteers are needed daily – not just during the holidays to help prepare meals for our community 365 days a year.
  • Make a donation – If you are interested in making a financial contribution, check to see if there are matching donation programs to make you financial gift go further.

Whether you choose to support an organization like DC Central Kitchen or another important community organization, partnerships like the one with Kaiser Permanente’s Center for Total Health, help to highlight the many initiatives underway that are needed to address real problems in our community. I’m even featured in the Center’s farmers market display where you can hear me talk about my perspective on solving hunger, as well as the perspectives of others on food as a strategy for healthy communities. Check it out for yourself by visiting the Center for a tour!

About DC Kitchen:

DC Central Kitchen, located near Union Station in Washington D.C., is a nonprofit developer of innovative social ventures that break the cycle of hunger and poverty. Our mission is to use food as a tool to strengthen bodies, empower minds, and build communities. At DC Central Kitchen, we do more than just feed those in need. We run a 14-week culinary job training program to create economic stability for unemployed adults so they can leave hunger behind. Our social ventures provide 1.8 million meals for our community as well as healthy, locally-sourced meals to students at 15 low-income schools in DC.
If you would like to drop off items to DCCK, here are a few drop-off guidelines to follow, once you have successfully collected your items, you can drop them off during our regular hours, as follows:

  • Our regular hours for drop-offs are 8 a.m. – 4 p.m. on weekdays and 8 a.m. – 3 p.m. on weekends.
  • DC Central Kitchen’s physical address is 425 2nd St. NW, Washington, DC 20001. Please ensure that you receive a receipt for your donation from our on-site staff as we need to keep track of all food we receive. Donations are tax-deductible.
  • DC Central Kitchen is often able to pick up especially large donations. However, we greatly appreciate it if you are able to bring donations to our location. Please contact our food recovery team (foodrecovery@dccentralkitchen.org or 202-400-2804) in advance if you need to schedule a pick-up.

 

The dirty truth about receipts

by

Guest blogger Joel Sigler is senior manager for Kaiser Permanente National Environmental, Health & Safety

The Center for Total Health has a self- service health assessment machine that provides visitors a printed receipt indicating their weight and body mass index (BMI). Recently, a visitor asked a great question about whether the receipt paper is coated with Bisphenol A (BPA).

BPA is an endocrine disrupter that mimics estrogen in the body. Studies have found that BPA exposure is potentially linked to a number of health concerns including breast cancer, diabetes, heart disease, sexual dysfunction, and obesity (kind of ironic if present in a machine that tells you your BMI). There are many sources of BPA exposure, it is found in many products including food can linings and plastic bottles. Unfortunately, receipt paper is one of the many items that can also potentially contain BPA. Receipt paper is of particular concern because it can easily be absorbed into the body when the receipt is handled. Absorption of BPA is sped up even more if hand sanitizer has been applied before handling a receipt.

23310950289_bdc9255b83_z
We promptly called the manufacturer of the self-service health assessment machine to find out if they knew if the receipt paper contained BPA. The good news is that the manufacturer was very responsive. Within a day they had contacted their receipt paper supplier and verified that it was “BPA free.” They even provided KP a letter from the receipt paper supplier. Kaiser Permanente is continuing to communicate with them to find out about any BPA alternatives that they may be using. Bisphenol S (BPS) and Bisphenol F (BPF) are chemicals commonly used as substitutes for BPA. They are less studied than BPA and haven’t gotten the same attention. But because BPS and BPF are similar in chemical structure to BPA, experts have concern that they could represent similar health risks.

It is important to recognize that product manufacturers aren’t always this responsive. It often takes a lot of effort to get an answer to whether a product contains chemicals of concern, either because they don’t know, or because they don’t think it is important enough to find out. In this case, the question had gotten to the President of the manufacturing company and apparently he had gotten similar questions from other customers. So just asking the question helps drive action. It is unfortunate though that when it comes to chemicals of concern, the onus is on the customer/consumer (and not on manufacturers) to drive efforts to find out if a product is “safe.” Kaiser Permanente puts significant effort into identifying and eliminating chemicals of concern like BPA in the products that the organization purchases and uses.

The Environmental Working Group provides the following recommendations to reduce exposure to BPA from receipt paper:

-Minimize receipt collection by declining receipts at gas pumps, ATMs and other machines when possible.

-Store receipts separately in an envelope in a wallet or purse.

-Never give a child a receipt to hold or play with.

-After handling a receipt, wash hands before preparing and eating food (a universally recommended practice even for those who have not handled receipts).

-Do not use alcohol-based hand cleaners after handling receipts.

-Take advantage of store services that email or archive paperless purchase records.

-Do not recycle receipts and other thermal paper. BPA residues from receipts will contaminate recycled paper.

More information on all of Kaiser Permanente’s environmental stewardship program can be found at kp.org/green

Physician Leadership in the Movement Toward Accountable Care

by

Blog by Elizabeth Keating
Senior Project Manager, Council of Accountable Physician Practices

“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization.”

This statement was made by Robert Pearl, M.D., CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. Dr. Pearl recently moderated a panel at the CAPG Colloquium held in Washington, DC, on September 29, 2016.

The panel, “Physician Leadership in the Movement Toward Accountable Care,” was hosted by the Council of Accountable Physician Practices (CAPP) and featured CAPP leaders discussing best practices in recruiting, training and developing physician leaders.

29508527154_41ac625504_z

“Healthcare systems should view physician leadership as a capital investment for the future with huge ROI,” said Dr. Pearl, who also serves as the chairman of the board of CAPP. “The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”

Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization.

“Every physician is a leader. We start with that assumption,” said Marc Klau, MD, Assistant Medical Director of SCPMG. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.

Dr. Klau described how SCPMG’s expansive geography allows for unique leadership development opportunities because programs begin at the medical center level. He explained that each medical center allows emerging physician leaders to build programs that work toward the Triple Aim goal. He stressed that this display of clinical excellence is critical to growing as a physician leader, because it builds trust among peers.
30101929496_d4cb7a8633_z

Dr. Klau also discussed how SCPMG’s leadership programs are geared toward training leaders in Permanente culture, not just administrative practices.

“It’s not about learning to log in to our electronic health record,” he said. “It’s about anchoring people in our history, quality expectations and developing communication skills.”

The panelists overwhelmingly agreed that physician leaders must possess emotional intelligence to be effective.

“The best leaders are going to be visionary but anchored in reality,” said Dr. Klau. “People who have a passion for doing something are the people who will move and change the world.”

The panelists agreed that physicians who are aspiring to lead their health systems or who think they might want to take on a more comprehensive role should start small. Emerging physician leaders could join clinical improvement committees or the first stage of a leadership program to determine if the track is right for them.

Health Care Topics Candidates Ought to Discuss

by

Dr. Robert Pearl, MD, Chairman and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, was recently interviewed by Bloomberg BNA’s Alex Ruoff about a primer on health care issues produced by the Council of Accountable Physician Practices (CAPP), which Dr. Pearl chairs. The primer was written for political candidates at all levels of elected office, and encouraged candidates to think beyond the success or failure of the Affordable Care Act (ACA) when considering health care policy.

The primer identified three issues that all elected officials should learn about to make the best policy decisions for their constituents. These include value-based reimbursement for doctors and hospitals, robust and coordinated use of health information technology, and improved quality measurement and reporting.

Dr. Pearl said in the article that neither Democratic candidate Hillary Clinton or Republican Donald Trump has spent much time discussing these topics during their speeches or in their official platforms.

“Both candidates have commented on the exchanges and the price of drugs, but there hasn’t been a discussion about the big changes needed in health care,” he said.

According to the article, although Medicare is already moving doctors into value-based payment systems, CAPP wants the candidates to commit to accelerating the pace of change and push for global capitation in which doctors are paid a flat rate based on the size and health of their patient population instead of for each service they provide.

The article goes on to assert that this shift could help to reduce the annual growth in Medicare spending, which according to the 2016 Medicare Trustees Report, is expected to increase as a portion of overall gross domestic product from its current level of 3.6 percent to 5.6 percent by 2040.

“When you look at what we’re spending on health care, it’s unclear why we’re not talking about changing payments,” Pearl said.

 

Source: Ruoff, Alex. Why Hasn’t Clinton or Trump Talked About Health IT? Bloomberg BNA, 31 August 2016.

Can you see me now? Video Visits at Kaiser Permanente

by

Dennis Truong, MD, is an emergency medicine specialist and the telemedicine director for the Mid-Atlantic Permanente Medical Group.

Smart phones and tablets are everywhere. Adoption of these devices now largely spans age, income, race and ethnicity. Americans, of all stripes, are emailing, tweeting, posting, banking, gaming, navigating, checking weather and so much more almost nonstop. Yet when it comes to using those nearly ubiquitous devices, only 2 percent report having access to video visits with their doctor.

In stark contrast, almost 9 in 10 family physicians believe telehealth – the suite of technologies and tactics to deliver virtual medical, health, and education services – is a way to increase access to care. Putting two and two together, that means far more than 2 percent of people should have access to video visits – a core component of telehealth.

Dr. Truong conducts a simulated video visit with a member.

Dr. Truong conducts a simulated video visit.

Why this disconnect? Telehealth regulatory policy for one. From the patchwork of state by state rules to privacy protections to reimbursement rules. Doctors (and some patients) also worry that telehealth has limited diagnostic and treatment value relative to face-to-face care and will adversely impact the day-to-day practice of an office. Not only does it interfere with the routine of quickly moving from one prepped patient to the next, it changes how you chart, plan for space in your office, bill and collect, and so much more.

The regulatory and payment framework must evolve, and technological advances in remote capabilities can help validate telehealth as a reliable solution. But it is easy to overlook the fact that none of it matters if doctors don’t want to change their norms. And, that adoption will fail if the consumer satisfaction barometer is not met as a result of a fragmented experience. At the Mid-Atlantic Permanente Medical Group (MAPMG), and all the Permanente groups of Kaiser Permanente, video visits have become a key part of our clinical offering. Making it work has been a case study in careful planning rather than chasing a “sexy” concept without judiciously working out all the details.

Since launching video visits three years ago, we carefully worked through the legal and regulatory steps. We put in the necessary equipment, trained every provider, collaboratively chose the specified set of clinical chief complaints that should be eligible for video, and slowly built video visit appointments into the schedule that gave physicians dedicated time for the care. The “competition” isn’t other providers. It is the doctor’s frame of reference. Is this as easy as when the patient is sitting in the exam room ready and waiting with forms completed, vitals collected, and nursing tasks done?

As the industry saw more platforms and pure-play video offerings emerge, we worked to stay true to a principle that says video care shouldn’t be fragmented from the normal care patients receive. Patients do not want to repeat themselves, pay for redundant tests, or fail to get a diagnosis because the doctor doesn’t have enough information to definitively make one. Nor do they want to have their “regular” doctor fail to provide care in consideration of what is known from any previous video encounters.

We purposefully integrated our solution into the same integrated electronic medical record we use for every face-to-face visit, telephone, or email visit. All the information is there to make the right clinical call. The ordering and referring process is identical (and can be done for the patient by the provider). The activity is visible to the patient’s regular provider(s).

When practiced right, it becomes as clear as the face on that smart phone screen that video visits are a powerful tool to improve access and patient satisfaction. The medical community needs to invest in making it not simply available to more patients, but making it available in a way that allows them to integrate that care with their overall primary and specialty care.