Building Healthy Communities Requires All of Us

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When multiple institutions across varying sectors work in alignment, we will create better health outcomes for everyone

Across California, 15 communities are working to address the biggest health issues in their regions, such as heart disease, diabetes, asthma, community violence, and trauma. They are doing this through an ambitious effort called The California Accountable Communities for Health Initiative (CACHI).

Kaiser Permanente is a proud partner of this effort because building a healthy community is possible when everyone works together for a common cause.  Unfortunately, too often, health care providers, nonprofits, schools, business and others work in isolation.

The good news is that through CACHI, leaders across California are now working in their local communities on a new comprehensive approach that brings a variety of local players together to improve the health and well-being of their residents. In 2016, Kaiser Permanente teamed up with the state’s leading health funders to launch CACHI and help provide the expertise, infrastructure and resources that communities will need to effectively work together.

To do this, CACHI is utilizing a new model known as the Accountable Communities for Health (ACH). This model requires us to confront outdated, conventional wisdom that doctors and hospitals alone can improve community health outcomes. An ACH is unique because it contains the infrastructure to provide a formal and structured vehicle for strong partnerships. It also establishes a Wellness Fund, designed to attract and weave funding and resources to support the long-term sustainability of the ACH. Furthermore, a key component is Community Engagement. Each of the CACHI communities will engage local residents, so they are involved in shaping this new model of health.

By working together, we can make sure that everyone thrives. We’re excited that an initiative like CACHI is expanding and modernizing the way we think about what a health system is and does. Learn more about these communities and their efforts on the new CACHI website: www.cachi.org.

 

Author Loel Solomon is the vice president of Community Health at Kaiser Permanente

Here’s What Happened in May at the Center

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If you haven’t visited the Center for Total Health recently, May was a busy month with events covering a wide range of topics and initiatives. In addition to hosting robust discussions about preventing violence, preventing and treating cancer, and creating innovative, healthy workplaces, we also had the opportunity to celebrate National Nurses Week (May 6-12) with leaders from the American Nurses Foundation. We not only welcomed this organization to the Center, but also showcased onsite displays that bring to life nursing leadership and communicate our appreciation for the difference nurses make in patients’ lives.

  • We welcomed the National Health Collaborative on Violence and Abuse (NHCVA) – including representatives from more than 30 health professional organizations – to discuss ways to reduce and address the health consequences of intimate partner violence (IPV) and abuse. Our very own Brigid McCaw, MD, represented Kaiser Permanente’s Family Violence Prevention Program, highlighting the crucial role health care play in caring for victims.
  • DC’s Colorectal Cancer Roundtable Summit brought local and national providers, advocates and educators to the Center to discuss the prevention and early detection of colorectal cancer and ways to improve screening rates to 80% by 2018 – a lifesaving goal set by the National Colorectal Cancer Roundtable. Joseph Territo, MD, of the Mid-Atlantic Permanente Medical Group, shared how Kaiser Permanente consistently ranks in the top 10% of the National Committee for Quality Assurance (NCQA) HEDIS Measures, which assess the number of adults who have had appropriate screening for colorectal cancer. NCQA data is also featured throughout the Center’s onsite displays.
  • The Center hosted the third annual Better Together event, All Systems Go! Closing the Gaps in Cancer Care, with the American Cancer Society and the Council for Accountable Physician Practices. The event highlighted patient stories, representing how coverage and accountable healthcare systems can improve survival and reduce morbidity for people living with complex conditions like cancer.
  • We hosted the Network for Excellence in Health Innovation (NEHI) and challenged attendees to think about Health Care Without Walls, a mind-shift to caring for patients outside of conventional institutional settings. To help get the conversation started, the center’s staff presented “Imaging Care Anywhere,” an example of our own provocation used with staff to think about the next generation of care for Kaiser Permanente members.
  • CoreNet Global’s Mid-Atlantic Chapter turned to Center to host an educational event focused on The Healthy Workplace, highlighting the subtle nudges that can be built into our work environments to drive healthier behaviors. Architects, designers, facility managers and other professionals learned how improving the health and wellbeing of employees through facility design can improve an organization’s bottom line, and also toured the Center’s interactive space to see the learnings come to life.

During the month, the Center also hosted meetings on improving prenatal conversations, credentialing of community health workers, and increasing the quality of ambulatory services, and welcomed a wide range of students, health care leaders, government employees and medical professionals for tours of our interactive and educational facility.

The Center for Total Health hosts third-annual Better Together Health

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From left to right: Jayne O’Donnell (Moderator), Laura Seeff, MD, Alan Balch, PhD, John Bulger, DO, Michael Kanter, MD

 

On May 24, the Kaiser Permanente Center for Total Health hosted All Systems Go! Closing the Gaps in Cancer Care, the third-annual Better Together Health event, led by the American Cancer Society (ACS) and the Council for Accountable Physician Practices (CAPP). The event highlighted patient stories, representing how coverage and accountable healthcare systems can improve survival and reduce morbidity for people living with complex conditions like cancer.

Laura Fegraus, Executive Director of CAPP led opening remarks with an overview of the state of cancer care in America. She presented research on what physicians and patients value, with evidence-based medicine, doctor-patient relationships, and care coordination topping each list. “Patients aren’t getting what they need,” she says, stressing the importance of coordinated care. “We are not there yet, and that’s why we’re here today.”

Robert Pearl, MD, Chair of CAPP (@RobertPearlMD), provided contextual framework for the event’s discussion of gaps in American health care, citing his recently published book, Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong. “If we cannot lower the cost increase [in health care] and do it through better quality, coordination, technology and leadership, the system will get disrupted. This is the time to change.”

Danielle Carnival, PhD, Deputy Director of the Biden Foundation’s Cancer Initiative provided a sense of hope, urgency, and change in the approach to cancer care by encouraging partnerships. Discussing racial and socioeconomic disparities, she stated: “Culturally appropriate cancer outreach efforts are needed to reach people where they are.” Dr. Carnival alluded to Cancer Moonshot in the goals of The Biden Foundation’s Cancer Initiative, which she says will “break down silos that stand as barriers for patients.”

After viewing two patient stories: Hunter’s of Geisinger Health System and Daria’s of Kaiser Permanente, Jayne O’Donnell of USA Today moderated a panel discussion featuring Alan Balch, PhD, CEO of the Patient Advocate Foundation, John Bulger, MD, Chief Medical Officer for Population Health, Geisinger Health System, Michael Kanter, MD, Medical Director of Quality and Clinical Analysis, Southern California Permanente Medical Group, and Laura Seeff, MD, Director of the Office of Health Systems Collaboration, CDC.

Dr. Kanter said the detection of residual cancer in Daria’s case and so many others is “the obligation of every [PMG] physician to look at the whole patient.” In the case of barriers for change in the current health care system, he said, “There’s issues of will and physician leadership.” Dr. Bulger agreed that “physicians need to coordinate care, rather than work against each other.”

Addressing a lack of data use, Dr. Balch called on physicians to harness data. “Data creates evidence to drive action, linking science to prevention,” Dr. Seeff said. Referring to the researchable data on preventable cancer deaths, Richard Wender, MD, Chief Cancer Control Officer, ACS, stated an increase in survival rates requires “a need to invest in a disproportionate way what is proven to work.”

Dr. Seeff reminded that in “cancer survivorship, it’s key to remember the human element.” There are several factors blocking patients’ access to cancer, outside of treatment, such as logistics, transportation, and food security, among others, Dr. Balch warned.

Office of the National Coordinator Deputy Assistant Secretary for Health Technology Reform John Fleming, MD, gave a keynote address on policy. His suggestion that “Every American should have a single, unified electronic head record available in the cloud,” from anywhere, at all times, for all involved physicians to access was met with approval from event audience.

While the outlook on American healthcare is uncertain, the panel and speakers are hopeful. They agreed with Dr. Kanter that for now, “Nothing is more important than the issue of health care access and coverage.” For more information on Better Together Health, click here.

Violence and Your Health

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The National Health Collaborative on Violence and Abuse (NHCVA), comprised of more than 30 national health professional organizations dedicated to addressing the health consequences of violence and abuse, held its annual meeting this month at the Center for Total Health. Brigid McCaw, MD, of Kaiser Permanente’s Family Violence Prevention Program participated in the meeting. “What I love about hosting meetings here at the center is the connections that you make. The center allows conversations to happen that are bigger than the building itself, bigger than what’s just included in its four walls. Diverse groups gather here and tackle issues bigger than themselves and implement real solutions to problems that impact everyone’s health.”

Two focus areas emerged during the meeting: 1) education of health care professionals from all disciplines and 2) understanding current/potential legislative policy on issues related to adult, child and elder abuse. All forms of violence were discussed. Speakers from medical societies, advocacy orgs and the federal government shared best practices so everyone could learn from one another.

“The relationship between violence and health is becoming more well-known. We know that exposure to violence as a child can impact your long-term health, said Paula Amato, MD, immediate past chair of NHCVA. “We need to promote the science of violence to the next generation of health care leaders.  Partners such as Kaiser Permanente, as well as other member organizations, are helping shape that progress.”

Moving forward, NHCVA members would like to see greater access to resources for victims of violence.  Health care providers and health systems are starting to share best practices in caring for victims of violence. Longer-term and, perhaps more pro-actively, health care systems can play a bigger role in the prevention, the intervention and the promotion of healthier relationships.

Futures without Violence is a member of NHCVA. Futures offers numerous resources for trauma-informed care. Through the collaborative work facilitated through NHCVA, we can expect to see promotion of tools for clinics and health professionals as well as discussions on what models of care are available to be better integrate care for victims of violence wherever they enter the health care system.

Ultimately, violence is just as much a part of someone’s health as are other social and behavioral determinants of health (e.g., race, ethnicity, food insecurity, depression, substance misuse, etc.)  Thankfully, the work of NHVCA are starting to raise the visibility of this issue and bringing forth the opportunity for real change.

Just Breathe….Smoking Cessation Support

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While it is difficult to overcome the addiction of smoking and completely kick the habit, different strategies and tactics can help control the desire to smoke in certain situations. To help, Kaiser Permanente established an online program called “Breathe,” free for Kaiser Permanente members 18 years or older. The program gives you a closer look as to why it’s so hard to quit smoking and ongoing support based on your unique needs. Components of this program include:

  • Tools to track and monitor your everyday process
  • A personalized plan to quit smoking
  • Relaxation and guided imagery podcast
  • Finding ways to cope with stress and deal with the urge to smoke

Nurse Practitioner Louis Casa encourages members to “try the program that has successfully helped 58 percent of its participants stop smoking”. She also expresses if you aren’t able to finish the program all at once, you can save your spot, then pick up where you left off when you return. That way, you can to finish at your own pace. You could also be confident that your privacy is protected and that the security of your own personal information will be maintained.

Another supportive resource Kaiser Permanente has is personal Wellness Coaching. These convenient phone sessions provide personal support to help members achieve their goals. Kaiser Permanente’s Wellness Coaching is available for five topics; tobacco cessation, stress management, physical activity, weight management, and healthy eating.

How Wellness Coaching works?

  • Patients are assigned a coach. During their first appointment, a coach helps assess your readiness and motivation. Are you prepared to make changes at this time?
  • After your first session, your and your coach will work together on how often you should meet by phone.
  • To make an appointment, call 1-800-862-4295, Monday through Friday, 7 a.m. to 8 p.m. (no referral needed, members are encouraged to call if needed)

 

For more information, the following resources are available online:

Always remember the four D’s:

  • Deep breathing
  • Drinking water
  • Delaying gratification- 2 minute delay helps
  • Doing something else

 

Nursing Leadership Now On Display

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2017.04.21 #MedStudent WellBeing at KP Center for Total Health 03367

In November 2016, I had the distinct (and long sought after) honor of meeting alumni of the Kaiser Foundation School of Nursing (KFSN).

Deana Medinas, Clair Lisker, Deloras Jones, and Phyllis Moroney are graduates of KFSN, which was open from 1947-1976, and graduated 1,065 health professionals.

Clair Lisker was a student of Dorothea Daniels, the first administrator of Permanente Foundation Hospital Los Angeles in 1953, and later the administrator of Kaiser Permanente San Francisco. Phyllis Moroney was the first nurse practitioner in California. Deana Medinas became the medical group administrator for Kaiser Permanente Hayward.

They didn’t know as much about Kaiser Permanente when they chose KSFN. However, they did know the Kaiser Foundation School of Nursing was ranked the #1  nursing school in California. And then they practiced and later helped build Permanente Medicine.

After our visit, Deloras shared these beautiful Legacy of Kaiser Permanente Nursing video stories, which we knew should also have a home here at the Center for Total Health.

So, on the day that the Kaiser Permanente School of Medicine came to the Center for Total Health for a historic dialogue on medical student well-being and resilience, our “Leadership in Nursing” was installed and ready, thanks to the Center for Total Health team.

In the photograph above, you can see the piece being played for the first time to an audience of medical education leaders from across the United States. Marc Klau, MD, Vice Dean of Education and Clinical Integration, is next to the display. Also present are Patrick Courneya, MD, and Ed Ellison, MD.

Most all of us encounter nurses in our life’s journey. I can tell you that physicians like me are trained by nurses in my own journey. To know where you’re going, it’s important to know where you came from. And there, you usually find people who live in the future, too (these nurses were practicing the kind of medicine in the 50’s that we are trying to get to today!) just like the 54,000 nurses who care for, treat and heal 11.8 million members across the care settings and specialties of Kaiser Permanente.

Taking Bids on Hospital of the Future

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garfieldAs Silicon Valley’s main hospital system and insurer, KP has been working with tech companies to respond to patient demands, and supply what the organization envisions it may need in the near future. Much of the testing is happening at the Garfield Innovation Center in San Leandro, California.

Kaiser Permanente Chairman and CEO Bernard J. Tyson sat down with Bloomberg Businessweek writer Caroline Chen to talk about the hospital of the future.

Read the Bloomberg story here. 

The Future of Care Delivery

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You walk in, verify at a kiosk that you’ve already checked in and paid, plug in your laptop at the charging station, and soon get a text that it’s your turn. No — you’re not at Starbucks — you’re at Kaiser Permanente’s new Signal Hill Medical Office in Southern California for your medical appointment.

Signal HillSignal Hill exemplifies Kaiser Permanente’s most recent effort of evolving its care model to better integrate into members’ lives.

“Granddad’s medical office building doesn’t cut it anymore,” said Don Orndoff, senior vice president, National Facilities Services.  “We’ve all now become accustomed to the Amazon and Uber experience and that’s our new expectation.”

The medical office of the future at Kaiser Permanente means harnessing design, technology and workflow to create an intuitive and convenient experience for members and care teams. It also means developing a much more agile and flexible environment that meets the evolving technology and service needs of those increasingly tech-savvy members and care teams.

Convenience and care under one roof

Signal Hill opened to Kaiser Permanente members on June 29, 2016, and its sleek architectural design doesn’t disappoint. But it’s the convenient technology features and efficient spaces inside that really impress. When you walk inside the building, you enter into the “public square.”

Since members have the option of checking in and handling their copayments at home, a quick visit to the kiosk allows them to take advantage of a number of options available to them in the public square. They can engage with others at the community table or use computers at the docking station. Or, they can decompress in a quiet spot on the upstairs “porch.” In fact, members can use their time wherever they wish because once the provider is ready, the member will receive a text message.

At the pharmacy, there is also no need to wait around. You’ll receive a text when your medication is ready.

signalhill2The exam rooms don’t look traditional either. Instead of the long, awkward exam table and steel chairs, there’s a comfortable reclining chair and a couch for family seating. The care team also uses hand-held tablets, which is not only easier for them, but avoids having the member stare at the back of a big computer monitor. On the wall, there’s a large monitor for virtual visits or patient education programs.

Read more of this story here. 

New resource to help identify and address social and non-medical needs

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Today marks the launch of the Social Interventions Research & Evaluation Network (SIREN) website, a new resource for health services researchers, clinicians, health system leaders, and others looking for evidence on what works to identify and address patients’ social and economic needs as a part of high quality health care.

Use the SIREN website to:

sirenkid

On the site you’ll also see they are accepting applications for SIREN’s Innovation Grants. The Robert Wood Johnson Foundation and Kaiser Permanente have teamed up with SIREN to support a small number of research projects to advance our understanding of the health care costs and utilization impacts of addressing patients’ social determinants of health. Grants will provide up to $150,000 total funding over two years.

Letters of Intent are due May 15, 2017 and full applications are due June 15, 2017.

SIREN’s mission is to catalyze and disseminate high quality research that advances efforts to address patients’ social and economic needs in health care settings. Learn more here.

 

When Conventional Wisdom Becomes Outdated: How new perioperative guidelines can save time, pain, and cost

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Maurice Cates, MD, is an Orthopedic Surgeon at Kaiser Permanente’s Fredrick Medical Center. He is the chief of orthopedic surgery for the District of Columbia and Suburban Maryland as well as the regional medical director for musculoskeletal service.

Surgery has been around for thousands of years. The advances in technique, pain management, and outcomes have been remarkable. Since the advent of modern anesthesia, one thing has stayed pretty consistent; those dreaded pre-operative instructions not eat or drink anything after midnight the day of your surgery. Here is to hoping you’re scheduled in the morning, right?

qem2The thing about those instructions is that they may not be helping – especially in several types of cases, one of which is total joint replacement. While improvements in minimally invasive techniques have helped reduce length of stay for something like a knee replacement from well over a week to about 3.4 days in the past couple of decades, our work at the Mid-Atlantic Permanente Medical Group (MAPMG) is validating that it could be as short as 1-2 days in most cases. Several cases are achieving “same day discharge” and we have even completed a total knee replacement in our free standing ambulatory surgery center where the patient had no need to be admitted to a hospital at all.

One in 25 adults over 50 in America lives with a knee replacement. With that kind of volume, cutting length of stay by some 2 days per case, and potentially moving cases from hospitals to ambulatory surgery centers, could deliver a tremendous cost savings for American health care with no detriment to quality. To get there, more physician practices and hospitals need to embrace the mantra of evidence-based medicine and examine how to safely apply ERAS®, as MAPMG does, to its joint cases.

ERAS stands for Enhanced Recovery After Surgery. It represents a shift in care involving all aspects of the patient’s journey through the surgical process, from preoperative care through recovery. The whole idea is to reduce surgical stress and disruption to a patient’s baseline physiology. ERAS protocols, in brief, focus on: (1) allowing the patient to have liquids prior to surgery, (2) narcotic pain medicines are minimized (we use intravenous acetaminophen instead), and (3) eating and walking/ambulation as soon as possible after surgery. Implementation requires thoughtful development of end-to-end care pathways, decision trees, and detailed post-operative outcome measurements. Doctors, support staff, and administrators must be invested in patient-centric care, and having a cadre of talented surgeons helps too – just the ingredients we have at Kaiser Permanente.

Medical evidence in the modern world of health care is an ever-growing body of knowledge. The more organizations continuously look to new studies and those producing the best outcomes (even if it comes from outside the United States, as ERAS initially did), the more people can receive the best care possible. After all, who wants to lie in a hospital bed for 3-plus days when there is the possibility of going home the same or next day? Our patient satisfaction data bump for those having surgery with ERAS and getting early discharge versus the traditional approach suggests the answer is nearly no one.