Organized Health Care Delivery System • June 2009
Kaiser Permanente: Bridging the Quality Divide with Integrated Practice, Group Accountability, and Health Information Technology D ouglas M c c arthy, K iMberly M ueller, i ssues r esearch , i nc . The mission of The Commonwealth Fund is to promote a high performance health care system. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.
J ennifer Wrenn
ABSTRACT: Kaiser Permanente—comprising the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and Permanente Medical Groups in eight regions—is the largest nonprofit integrated health care delivery system in the United States. The successful evolution of this organizational structure in a competitive marketplace has required a close partnership between managers and physicians supported by a culture of physician group accountability for quality and efficiency. An overarching agenda for achieving excellence focuses on high-impact health conditions, provides goal-oriented tools to analyze population data, proactively identifies patients in need of intervention, supports systematic process improvements, and promotes collaboration between patients and professionals to improve health. Central to this effort is KP HealthConnect, a comprehensive health information system that integrates an electronic health record with the tools to support physicians in delivering evidence-based medicine, coupled with a robust online patient portal that enhances members’ access to and involvement in their care.
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In August 2008, the Commonwealth Fund Commission on a High Performance Health System released a report, Organizing the U.S. Health Care Delivery System for High Performance, that examined problems engendered by fragmentation in the health care system and offered policy recommendations to stimulate greater organization for high performance.1 In formulating its recommendations, the Commission identified six attributes of an ideal health care delivery system (Exhibit 1). Kaiser Permanente is one of 15 case study sites that the Commission examined to illustrate these six attributes in diverse organizational settings. Exhibit 2 summarizes findings for Kaiser Permanente, focusing on the Northern California and Colorado regions as two examples of the organization’s model.
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Exhibit 1. Six Attributes of an Ideal Health Care Delivery System •
Information Continuity Patients’ clinically relevant information is available to all providers at the point of care and to patients through electronic health record systems. Care Coordination and Transitions Patient care is coordinated among multiple providers, and transitions across care settings are actively managed. System Accountability There is clear accountability for the total care of patients. (We have grouped this attribute with care coordination, since one supports the other.) Peer Review and Teamwork for High-Value Care Providers (including nurses and other members of care teams) both within and across settings have accountability to each other, review each other’s work, and collaborate to reliably deliver high-quality, high-value care. Continuous Innovation The system is continuously innovating and learning in order to improve the quality, value, and patient experiences...
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