WE BUILD A BRIGHTER FUTURE together Union Delegates Conference 2012 March 24, 2012 Raymond J....
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Transcript of WE BUILD A BRIGHTER FUTURE together Union Delegates Conference 2012 March 24, 2012 Raymond J....
WE BUILD A BRIGHTER FUTUREtogether
Union Delegates Conference 2012March 24, 2012
Raymond J. Baxter, PhDSenior Vice PresidentCommunity Benefit, Research and Health Policy
Stepping Up to Total Health
Page 2
Kaiser Permanente’s History
Our Mission for Generations: “To provide high quality, affordable health care,
and to improve the health of our members and the communities we serve”
Grand Coulee Dam - 1942 Grand Coulee Dam - 1942
Page 3
*NCQA market ranking based on state boundary, and not KP regional market. SCAL and NCAL ranked first within each of its KP regional
markets, but second in NCQA state market only to each other.
HEDIS Measures 2011
NCAL SCAL HI NW CO GA MAS OH
Childhood Immunization Status – Combo 2 & 3
Chlamydia Screening in Women - Total
Appropriate Treatment for Children w/URI
Adult BMI Assessment
Weight Assessment for Children –
BMI Percentile
Comprehensive Diabetes Care –
Medical Attention for Nephropathy
KP REGIONAL MARKET RANKING
1 1 1 1 1 1 1 1
1* 1 1 1 1 2
1 1 1 1 1 1 1
1 1 1 1 1 2
1 1 1
1 1 1 1 1
1 1 1 1
1
1 1
Breast Cancer Screening 1*
1 1 1
1
1 1 1 1
1 1
1
1 1
1*
1*
1*
1*
1*
We’re #1…Market-leading Prevention
Page 4
We’re #1…Market-leading Care
NCQA ranking of 341 Medicare health plans in US (2011)
KEY:1\ Medicare ranking out of 341 ranked health plans2\ Mid Atlantic ranked #1 for Medicare in VA, DC, and MD 3\ Northwest ranked #1 in OR and WA4\ Second only to the other KP plan in California
2
Northern California
Southern California
Colorado
Georgia
Hawaii
Mid Atlantic2
Northwest3
Ohio
KP Medicare RankingNational1 State
1
2
3
31
7
17
4
19
1
1
1
1
1
1
4
1
Page 6
We Must Address Health At All Levels
Deploying Kaiser Permanente Assets for Total Health
1Neighborhood /
Community
Society
Individual / Family
Home / School /Worksite
CommunityHealth
Initiatives
Environmental Stewardship
Clinical Prevention
Access to Social and Economical
Supports
Health Education
Public Education
WorksiteWellness
Public Policy
Research
Physical and Mental Health Care
Walking Promotion
Page 7
Many Factors Shape Health
Health is driven by multiple factors that are intricately linked – of which medical care is one component.
Family Historyand Genetics
30%
Environmentaland Social
Factors20%
PersonalBehaviors
40%
Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993
MedicalCare
10%
Drivers of Health
Page 8
Behaviors Shape Health
Actual Causes of Death in the U.S. in 1990 and 2000Actual Causes of Death in the U.S. in 1990 and 2000
*Data are from McGinnis and Foege. Percentages are for all deaths.*Data are from McGinnis and Foege. Percentages are for all deaths.
Actual CauseNumber (and %)
1990*Number (and %)
2000
Tobacco 400,000 (19%) 435,000 (18.1%)
Poor diet and physical inactivity 300,000 (14%) 400,000 (16.6%)
Alcohol consumption 100,000 (5%) 85,000 (3.5%)
Microbial agents 90,000 (4%) 75,000 (3.1%)
Toxic agents 60,000 (3%) 55,000 (2.3%)
Motor vehicle 25,000 (1%) 43,000 (1.8%)
Firearms 35,000 (2%) 29,000 (1.2%)
Sexual behavior 30,000 (1%) 20,000 (0.8%)
Illicit drug use 20,000 (<1%) 17,000 (0/7%)
Total 1,060,000 (50%) 1,159.000 (48.2%)
Page 11
Change in price of items since 1978, relative to overall inflation, as measured by the Consumer Price Index. The price of carbonated drinks, for example, has fallen 34 percent relative to all other prices.
Source: Leonhardt, 2010
What We’re Up Against
Page 13
0
0.1
0.2
0.3
0.4
0 100 200 300 400 500
Minutes Spent in Car Per Day
Pro
ba
bil
ity
of
Ob
es
ity
White Male White Female
Black Male Black Female
Slide courtesy of Richard Jackson, MD
What We’re Up Against
Page 14
Interventions: Individual
We know what to do…
AdviseScreen ReferAssist
… we have the tools…
… and we need to do it with each and every member.
Page 15
Interventions: Individual/Family
Smith, John W
Exercise As Vital Sign, Exercise Rx Tools, Tips, Motivation and Support
• Office-based
• Direct-to-member
• Online tools
• Cooking tips
• Recommend at least 150 minutes of moderate to strenuous exercise per week.
Page 16
Interventions: Activity
Regular walking can prevent misery
of colds
Raises HDL
Aerobic exercise helps strengthen the heart, lungs,
and muscles
Helps people with diabetes to control their blood sugar
Reduces risk of oseteoporosis
and broken bones
Reduces the pain and swelling from arthritis
Improves mood and energy
Gain 1.3-1.5 healthy years of
life
Evidence of Short and Long Term Benefits
Page 17
Interventions: Institutional
KP Farmers’ Markets Cafeteria menu labeling, KP Healthy Picks KP facilities as community assets Environmental stewardship Supplier diversity initiative
Page 18
Interventions: Employers
We have begun to offer a portfolio of services that can help KP customers, prospects and other organizations improve the health of their workforce.
• Standard & customizable print/web communications• HealthWorks Workbook
CommunicationsLifestyle Telephonic
Health CoachingAnalytics & Reporting
• HealthMedia Reporting• Exercise Pgm.
Reporting• Rewards reports• Kp.org activity reports
• Inbound coaching
Page 19
Interventions: Community Health
Healthcare• BMI as a vital sign• Breastfeeding promotion• Hospital cafeterias
Schools• Cafeteria reforms • PE standards, after school programs• Joint Use Agreements• Safe routes to school
Worksites• Stairwell prompts• Lactation support• Worksite wellness programs
Neighborhoods• Parks, trails and other active public spaces• General Plan amendments• Corner store conversion efforts• Farmers markets and community gardens
Neighborhoods
Schools
Worksites
Healthcare
Page 21
(1) Southern California
Kaiser Permanente Members With 150 Minutes or More of Exercise Per Week(1)
78.4%
41.0%36.0%
0%
20%
40%
60%
80%
100%
Age 12-17 Age 18-64 Age 65+
Current regional average = 43%
KP target = 100%
Less Than Half of the U.S. Population Meets Healthy People 2020 Objectives for Diet and Exercise
Source: BRFSS, 2007
Big Opportunities Exist for the U.S. and Kaiser Permanente
Page 22
Support Individuals Encourage Groups
Change Communities Track Outcomes
4 Diseases, 4 Risk Factors* 4 Kaiser Permanente Actions
*Aligns with World Health Organization’s framework for monitoring non-communicable diseases
An Integrated Approach to Diseases and Risk Factors
Page 23
A Total Health Portfolio
Total Health will require a coordinated set of activities, focusing on some key initial areas while developing core capabilities and enhancing efforts on work underway.
Total HealthFocus Areas
Healthy Schools
Workforce Wellness
Focus as first and relatively complete
demonstrations of Total Health, done
everywhere in KP
Core Capabilities“Fundamentals”
KP Integrated Care Model
Behavior Change strategies
Member Assistance Program
Effective Communications
Essential components needed to realize
Total Health
Applications of Total Health
Every Body/KP Walk!
The Weight of the Nation
HEAL/obesity prevention and treatment
Hypertension control
Disparities elimination
Work underway butTotal Health lens can help deepen the work
and re-double our efforts
Page 25
Vision: Schools Served by KP are the Healthiest Schools in America
* Draws from CDC Coordinated School Health, Alliance Healthy Schools Framework & WELCOA (Wellness Council of America)
What makes a healthy school?•Multi-component interventions
•Multi-stakeholder engagement
•Consultative support and technical assistance
Page 26
1Neighborhood /
Community
Society
Individual / Family
Home / School /Worksite
Neighborhood & Community & School: Policy / Environmental Assets Cafeteria / vending
reforms Universal breakfast
PE standards Safe routes to school Joint Use Agreements
Photovoice School wellness
councils
Eligibility determination for federal nutrition programs
School: Student-Focused Assets Educational theatre KP volunteers Mentorship programs School-based health
centers Outreach / enrollment for
subsidized insurance TV turnoff
SPARK PE interventions Every Body Walk! School gardens Farm to school Fitnessgram PlayWorks
KP Is Already Delivering on Many Total Health Components for Schools, Their Staff and Students
Worksite: Staff -Focused Assets Consultative support to
create a wellness strategy
Biometric Screenings Health promotion classes Incentive programs Healthy lifestyle programs
FruitGuys Healthy Picks Toolkits Every Body Walk! Thrive Across
America 10,000 Steps
Individual / Family: Member-Focused Assets across the Health Continuum
Promoting Health Anticipating Health Risks Managing Chronic Conditions• Immunizations• Self-care tools & resources• Best-practice care• Proactive outreach• Referrals without pre-approval• Registry data tracks risk factors
• Preventive care: EVS & BMI and counseling• E-mail providers• Health education & promotion including classes for families• Online resources & telephonic coaching• Well child visits and sports physicials• Menu Labeling
• Comprehensive services for KP members
• Forty CHI sites integrate student health components at a local level
• Grantmaking, technical assistance and advocacy support district- and state- level change
• Employee wellness offerings are available to schools across KP through HealthWorks (~250 CA school districts)
Page 27
Launch Fall 2012
Launch Fall 2013
Launch Fall 2013* Lower
Reach / Higher Intensity
* Higher Reach / Lower Intensity
Healthy Schools: Tiered Model for High Reach and High Impact
Offer a “KP Healthy Schools” tiered product available to all schools within Kaiser Permanente’s existing footprint. Leverage and integrate existing KP assets including HealthWorks, Community Benefit and the delivery system alongside a national partner.
Page 28
Our Mission of Generations:“To improve the health of our members and the communities we serve”
KP’s Origins: The Health of the Workforce
Page 29
Total Health Aspiration: KP Workforce is the Healthiest in Healthcare
Workforce Vision
KP workforce is productive, healthy, thriving, leading satisfied lives and fulfilled careers, committed to KP vision, highly skilled and engaged in
learning and improvement, creative, flexible, positive, resilient
Page 30
Healthy Hospital Choices: Recommendations and Approaches from an Expert Panel
Food/Beverage
Physical Activity
Breastfeeding
Tobacco Cessation & Control
Dissemination & Surveillance
• Health sector and public health have an opportunity to address the nation’s chronic disease burden and health care costs by promoting healthy hospital food environments. • Healthy food is to be defined not only by nutrition standards but also by an economically & environmentally sustainable food system.• Current food environment measurement tools should be further adapted for hospitals.• Food policies should cover all venues, including cafeterias, vending machines, snack carts and gift shops.
• Health sector and public health have an opportunity to address the nation’s chronic disease burden and health care costs by promoting healthy hospital food environments. • Healthy food is to be defined not only by nutrition standards but also by an economically & environmentally sustainable food system.• Current food environment measurement tools should be further adapted for hospitals.• Food policies should cover all venues, including cafeterias, vending machines, snack carts and gift shops.
• Promote trails, public spaces and use of hospital facilities for physical activity opportunities.• Create policies that promote access to facilities and time for physical activity during all hospital shifts.• Connect physical activity strategies to emerging evidence and national efforts to combat obesity.
• Promote trails, public spaces and use of hospital facilities for physical activity opportunities.• Create policies that promote access to facilities and time for physical activity during all hospital shifts.• Connect physical activity strategies to emerging evidence and national efforts to combat obesity.
• Breastfeeding is encouraged by most major health agencies.• Hospitals are a unique setting in that they can support breastfeeding for employees, patients and visitors.• Hospitals should support breastfeeding by providing break rooms and time for expressing breast milk for employees and, where possible, for visitors.
• Breastfeeding is encouraged by most major health agencies.• Hospitals are a unique setting in that they can support breastfeeding for employees, patients and visitors.• Hospitals should support breastfeeding by providing break rooms and time for expressing breast milk for employees and, where possible, for visitors.
• Customary hospital practices and resistance from employees and patients who smoke may pose barriers to efforts to implement tobacco-free hospital campus policies, but these barriers can be overcome with careful planning and preparation.• A tobacco control model can incorporate Joint Commission performance measures and achieve a high level of compliance to effective policies and practices.• Coverage of tobacco cessation treatments varies by health insurance plan and availability of services varies across communities.
• Customary hospital practices and resistance from employees and patients who smoke may pose barriers to efforts to implement tobacco-free hospital campus policies, but these barriers can be overcome with careful planning and preparation.• A tobacco control model can incorporate Joint Commission performance measures and achieve a high level of compliance to effective policies and practices.• Coverage of tobacco cessation treatments varies by health insurance plan and availability of services varies across communities.
• Successful strategies to improve hospital environments include identifying partners, such as public health, with clearly defined wellness goals, tailoring messages and garnering executive endorsement.• Healthcare providers can be engaged as effective advocates to disseminate and make changes to nutrition and physical activity environments within their own institutions.• Demonstrating linkages to other hospital priorities and creating a recognition system is a key element.• A national assessment tool and indicators for large scale success will help in disseminating best practices.
• Successful strategies to improve hospital environments include identifying partners, such as public health, with clearly defined wellness goals, tailoring messages and garnering executive endorsement.• Healthcare providers can be engaged as effective advocates to disseminate and make changes to nutrition and physical activity environments within their own institutions.• Demonstrating linkages to other hospital priorities and creating a recognition system is a key element.• A national assessment tool and indicators for large scale success will help in disseminating best practices.
Page 31
Healthy Eating
Healthy Eating
Healthy Physical Environment
Healthy Physical Environment
Healthy Activity at Work
Healthy Activity at Work
Workforce Wellness: Where to Start?
Page 32
Workforce Wellness: “Champion” Level
Source: Dee Edington, Zero Trends: Health as a Serious Economic Strategy, Health Management ResearchCenter, University of Michigan, 2009Note: HERO, WELCOA, and NBGH models contain same fundamentals
Create the Vision
•Commitment to healthy culture
•Connect vision to business strategy
•Engage leadership in vision
•Leaders are held accountable
Align Workplacewith Vision
•Engage everyone
•Brand health management
strategies
•Integrate policies into culture
Create Winners
•Help employees not get worse
•Help healthy employees stay
healthy
•Provide improvement &
maintenancestrategies
ReinforceCulture of Health
•Reward champions
• Set incentives for healthy
choices
•Reinforce at every touch point
Outcomes Drive Strategy
•Integrate all resources
•Measure progresstowards goals in
first 4 pillars
•Strategic, Systemic,Systematic,Sustainable
Senior Leadership
Operations Leadership
Self Leadership
Reward Behavior
Quality Assurance
Fundamentals Required for Transformation to Champion Level
Page 33
Kaiser Permanente has assumed a leadership role in promoting the power of walking
Collaborative development of two dynamic online programs: For Kaiser Permanente Employees: KP Walk!
Get Involved: www.KPWalk.com
For All Americans: Every Body Walk! Get Involved: www.EverybodyWalk.org
We Have to Engage People in the Solutions