Making a difference in Southern Colorado

Tuesday, July 01, 2014 12:13 PM

C. Rocky White, MD, Market Medical Director, Kaiser Permanente Southern Colorado and Richard Spurlock, MD, Medical Director of Network Relations and Development, Kaiser Permanente Southern Colorado

Population health program demonstrates results

Kaiser Permanente has long incorporated the concept of population health within an integrated delivery system. But until recently, there has been little data to show how population health and managing chronic conditions can improve outcomes in a health care model where physicians operate independently in a community setting.

Fortunately, providers of Kaiser Permanente’s Southern Colorado region are already seeing some positive empirical evidence that population health works in a Collaborative Care Model we implemented in 2012. Results include the following:

• We have observed an increase in hypertension control of 7 percent.
• The control rate in our diabetic population increased by 12.5 percent.
• We developed a scorecard and worked with our OB/GYN practices in the region to reduce the number of elective deliveries before 39 weeks. When deliveries are induced electively prior to 39 weeks gestation, babies have a higher incidence of neonatal complications and may not be mature enough to thrive on their own (requiring intensive intervention).

Though we have demonstrated that giving groups the tools they need to do population management leads to measurable positive results, we have faced the same set of challenges as most of Colorado’s commercial health care sector.

Members who see Kaiser physicians in our medical offices are connected to their physicians and care teams through that electronic medical record, enabling increased care coordination. However, in Southern Colorado, approximately 90 percent of our 60,000 members visit contracted physicians through a Preferred Provider Organization (PPO) outside of our integrated system.

Even though Kaiser has a very robust health information technology (HIT) program inside our integrated system, we are unable to exchange electronic medical records with individual practices – the interoperability is not yet there. Due in large part to this fragmentation of the system, the metrics revealed a significant disparity between Southern and rural Colorado and our more integrated markets. Considering that Southern Colorado is in a sense a “test kitchen” for Kaiser’s PPO, a different kind of vision was needed.

We developed a pay-for-value program where we engaged adult primary care offices, pediatric practices, cardiologists and OB/GYNs around quality programs. We started with some of the larger groups by initiating a few quality metrics that physicians could agree upon. We began with five metrics for diabetes, one for high blood pressure, and three additional prevention measures, including breast cancer, cervical cancer screening and colon-rectal cancer screening.

Then, we provided financial incentives to hit certain targets and improve those quality metrics. Initially, there was some pushback to the program because providers are resistant to an insurance company coming in and telling them what to do. But we took the approach that physicians are highly motivated to make a difference in individual patients’ lives, and a Kaiser Permanente physician, along with Kaiser Permanente nurses and support staff worked with them to help them do so.

We helped one reluctant physician set up a separate registry for his 30 diabetic patients. Within a year, he saw an improvement in the metrics of those patients and installed an electronic medical record (EMR) system when his practice saw the clear benefits of population health.

In another case, Kaiser gave a provider a list of patients who had not had breast cancer or colon-rectal cancer screenings. The practice succeeded in bringing in many of those on the list for screenings. The tests for two of those patients revealed early detectable cancers that were treated in the early stages – potentially saving both patients’ lives and avoiding more costly treatment later on.

For many practices, population health is the right thing to do but difficult to implement. But when you break down the barriers and provide a stipend for improving patient care, a nursing staff to provide outreach support, as well as educational resources about population medicine, the practices enthusiastically deploy new procedures.

Sometimes, implementing population health simply means helping an engaged staff understand the concept, gather office charts, and develop a spreadsheet around targeted patients. You don’t necessarily need a fancy EMR to do this (though it’s easier and more accurate).

From our observations, the tenants of population health really resonate with health care professionals when they see the difference it makes in individual patients’ lives. At the end of the day, that’s what Kaiser is about, and that’s why these professionals are in their field.