A while back I was asked by Ri De Ridder if I wanted to go to Kaiser Permanente in San Francisco. A very tempting proposition since the Kaiser Permanente care model is often cited as a leading example in the preparation for the ‘Eerstelijnsconferentie’ in Flanders (primary health care conference ) and pilot projects Chronic Care. The trip turned out to be very exciting and I came back with a lot of inspiration.
Kaiser Permanente has 10 million members and is present in eight US states. Kaiser Permanente has:
- 38 hospitals
- 622 outpatient clinics and other outpatient facilities
- 18,000 physicians
- 180,000 employees, including 50,000 nurses and 6,000 employees in the IT department
The focus is strongly oriented on health care, welfare is not included in the health care offer of Kaiser Permanente.
What can we learn from Kaiser Permanente?
“Keeping people healthy” is the motto. Kaiser Permanente is both an insurer and a healthcare provider. The less care costs customers make, the better for the insurer. Therefore, massive investments in prevention are made. Each hospital has a health education center where information is available and coaching and training are provided on specific topics, such as diabetes, HIV, mental health,… In addition, a lot of digital information is available on videos, online courses,… Kaiser also invests in health promotion by their own employees. For example, corporate objectives are designed in the area of eg. obesity. When the objective is attained, everyone receives a bonus.
Measuring quality and benchmarking
Knowledge is power: Kaiser Permanente sets clear goals ahead in terms of outcome and puts these goals higher every year. More specialized care is only available in certain hospitals within the group, the ‘Centers of excellence’. And Kaiser Permanente is proud of the good results they can present compared to other US hospitals in terms of outcome.
Innovation and digitization
The most impressive within Kaiser Permanente is the fully integrated digital system for all hospitals and clinics with a highly developed personal health record. It has taken seven years to develop the system and it is still constantly built upon, which an annual investment of about 5-7% of the costs in IT. And the result is amazing: in the electronic patient portal all the information is available to the patient (labs, letters, information on the treatment,…) and through the system it is even possible to make arrangements, to mail the doctor, to perform consultations through video conferencing, to order medication online, to fill in preoperative questionnaires, to search for information,…
For physicians and other health care professionals, the system provides a lot of digital support: mobile apps, alerts for upcoming necessary screenings and investigations, the ability to schedule appointments with other caregivers, evidence based guidelines,… The possibilities are beautifully illustrated in the video below:
The doctors and the IT department work closely together in the development of the IT system. Or as the Vice President of Health IT Strategy puts it: “A system entirely built by doctors is unpayable, one entirely built by IT professionals is unusable, both groups have to cooperate.”
The Garfield Innovation Centre makes up the heart of the Kaiser Permanente Group, dedicated to experiment and to push back the current limits, regardless of the existing structures. Here, new technologies and forms of care are tested and adjusted. Also, patients are involved in the development and testing of these innovations. To set up this innovation center, Kaiser was inspired by Google and McDonalds. Some innovations go pretty far, including a digital doctor:
And the business case? According to Kaiser Permanente it’s positive, mainly due to the decrease in the length of stay and reducing of administration by nurses. There are also economies of scale by developing the system for a larger population (in the case of Kaiser Permanente for 10 million members, 38 hospitals and 622 outpatient clinics)
It’s always a challenge in health care to break out of our silos and the Garfield Innovation Center provides an exciting physical space that energizes our staff to work collaboratively on innovations which will provide our members with the best care.”
Jennifer Liebermann, Garfield Innovation Center Director
And what lessons can we draw for our country?
- Focus on prevention and health promotion in order to increase the efficiency of the health system (and of course to improve the health of the population).
- An integrated electronic system is the basis for integrated care. At that level, we are still far behind in comparison to Kaiser Permanente.
- Dare to experiment. Create space, time and resources to elaborate new technologies and forms of care – regardless of the existing structures – together with patients and caregivers.
If you would like more information about the visit, don’t hesitate to contact me!