Since we love to gripe about healthcare providers, but seldom get an opportunity to talk together frankly, I was excited to finally run into a few executives from Kaiser Permanente (KP) at a healthcare blogging occasion. Enjoy ’em or hate ’em, Kaiser is America’s leading integrated health care company with a distinctive nonprofit business model (and also those cool “your-couch-is-a-carb” / / Thrive advertisements).
They are extremely interested in Social Media, therefore it didn’t take too much coercion to make them agree to a DiabetesMine.com interview with one of their most articulate (and pragmatic) leaders. Dr. Michael Mustille serves as “Associate Executive Director, External Relations.” An extremely major PR title. However, Dr. Mustille is likewise an occupational medicine doctor with 33 years’ expertise and former manager of the South San Francisco KP health centre. He now sits at the executive director of the Permanente Federation, the organization’s medical arm, and can be personally involved in rather a range of health quality initiatives.
Oh, the irony! Of course I conducted this interview before last week allegations of mismanagement and medical misconduct hit the fan.
Anyhoo, here is what Dr. Mustille needed to say about what he believes makes Kaiser powerful and how this impacts individuals with diabetes.
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DM) Kaiser has been pioneering in best practices for chronic disease control, even launching the subsidiary KP Healthy Solutions to let their expertise. What exactly does KP actually do so well here for diabetes patients particularly?
MM) Why is Kaiser is such a leader in healthcare? I’d say it is all about Quality of Care. We’ve shown this consistently, and within the previous decades two things stand out: our treatment for chronic conditions and also our “health & wellness” push to find the greatest possible prevention and screening.
This is in fact substantiated using standardized quality performance measures, such as those from the NCQA, that monitors quality health and certifies health plans/HMOs throughout the country. They use a standardized data set, and also a publicly available rating methodology. (You can look up report cards on almost any HMO in america.) Kaiser is at or near the top round the Nation.
These standards include, by way of instance, a bundle of diabetes-related steps for individuals: Can you get your A1c tested? Your lipids tested? Your microalbumin measured? We do occasionally examine patients, but we track the quality of care received from our recordings, including claims data and chart reviews.
Obviously, quantifying in these ways is not the same as making people healthy inside their daily lives. For this, we are in need of a coordinated application of actions/treatments which help get patients where they have to be health-wise — in this instance, if they have pre-diabetes, full diabetes, or complications of diabetes have established in.
DM) How simple is it for diabetes patients with Kaiser to get their own “diabetes care team” — endocrinologist, CDE, nutritionist, podiatrist, etc. — to actually communicate and work together?
MM) One big benefit is shared medical documents. At Kaiser, all those people today work in the same organization, usually at the same location. In a less coordinated system, your providers are across town and each has their own medical documents — that are incomplete, because they only demonstrate the care you received at that office. KP providers work shoulder-to-shoulder with the same records, measuring real outcomes.
We cure 277,000 patients throughout the country with diabetes (out of 8.5 million KP members complete). We all know that their A1c, whether have observed the doctor or where in the hospital recently, and if they’ve filled their diabetes prescriptions. We can tell who they are, where they are, and what degree of control they have, therefore we really know what works concerning team care.
We’re making a real effort now to further advance health information technologies with a brand new suite of software programs called KP HealthConnect(Editor’s note: that has also come under scrutiny). Everything significant for each member is recorded digitally, including visits, lab results, prescriptions, etc.,– no more paper records. The information could be shared with any KP provider anywhere.
We’d also like to see interoperability outside of the KP system, therefore emergency teams along with other critical providers possess some way to retrieve and transmit vital patient information. We’re engaging in a national effort to nurture the Interoperability of Medical Records.
DM) Isn’t Kaiser helping establish standards for transfer of data from many different kinds of health tracking systems (that the Continua Health Alliance)? What are a few of the roadblocks or hot buttons there?
MM) Yes, this is a different problem, which is how to create medical devices “speak to one another. “Kaiser is a charter member of their Continua standards committee. The focus is on Home Monitoring Devices — scales, sugar monitoring, blood pressure apparatus etc — would link mechanically with each other to some degree and also to a database at your supplier’s site.
We’re proficient at designing systems which seem strong, but are siloed, meaning they work great only in the range of their wants, but don’t contribute to your overall medical care. A lot of new apparatus beg the question: Is this really beneficial? Or simply confusing, and possibly even dangerous?
These systems are very fresh, and people tend to lump numerous different monitoring technologies together. What is their value, and for whom? These questions will need to be answered by doing a few studies.
DM) What about going into continuous glucose monitoring (CGM) because the quality of diabetes treatment? Where does Kaiser stand on this particular issue?
MM) One of the nice things about practicing medicine in KP is the fact that if you’ve got a excellent idea on how best to help individuals, you can go ahead and try it out. A few of our endocrinologists in Southern California recognized CGM engineering early on and decided to try it. They experimented with patients utilizing Minimed’s model and found it quite useful for hypoglycemic unawareness. However, many Type 2 diabetics may do quite well with this system.
DM) Are individuals encouraged and/or encouraged to try the latest cutting-edge treatments?
MM) In Kaiser, a CGM apparatus would be covered if the patient can’t achieve good glucose control even after exhausting all of the other attempts. This is, we have a step-wise (or evidence-based) way of employing new remedies. We’ve got quidelines for what therapies are appropriate to begin with, and what is the next step and the next step then.
We don’t look at these items insurance choices. These are medical decisions at KP.
It actually is an issue of the person and their doctor making the decision; should they think that current therapy is not working well, they could decide to proceed to the next step.
DM) How can your approach particularly progressive or distinct from what other healthcare organizations do?
MM) We actually have evidence that diabetes patients at KP do better than everywhere. For one thing, we have an innovative way of assessing actual costs. We’ve developed an analytical motor utilizing clinical and financial information to gauge the costs of covering certain inhabitants. By way of instance, we can take all the available information for folks who work in a rubber plant at Des Moines, Iowa, and estimate costs for this population.
With this predictive model we could compute outcomes 10 years from now when we alter the peoples’ therapy, i.e. when we implement a nutrition program or put them on certain medicines, what is the likely impact on their health issues? This is actually significant information, because we could save thousands of dollars and stop countless heart attacks!
In terms of diabetes care, we could understand that there’s generally a return on investment (ROI) of 2 or 3 dollars on each dollar set in. That is strong financial evidence that proactive diabetes therapy is a enormous cost savings for providers in the long term. For employers, in addition, it implies less absenteeism, no extra money wasted in simple treatments, and so forth.
DM) How does all this play from the individual’s perspective?
MM) We provide our expertise via web-based and telephone training, in which patients have direct contact with caregivers who help them develop plans for their individual needs. This isn’t only for chronic conditions, but also for nourishment, exercise, stress reduction, end-of-life care, plus even more. Here is the support which KP Healthy Solutions helps provide to organizations outside of Kaiser.
We’ve had the largest impact (cost savings and outcomes) with chronic conditions like asthma, diabetes, coronary heart disease, heart failure, and depression.
Depression is amazingly important. We’ve discovered that, by way of instance, a diabetic manhood generally spends 4x as many days at the hospital compared to an average member. With depression and diabetes, the member spends 8x as many days at the hospital. So among the first things we do is monitor patients for depression. In addition, we train our care teams on how best to determine motivational factors, and we’re making counseling part of the therapy program.
DM) What about early intervention and pre-diabetes care?
MM) We have guidelines for this, 220 pages of these! Seriously, if a man has a family history of diabetes or other markers, then we are doing Favorable screening. In addition, we understand you can’t use this sort of care for a cookie cutter approach; it needs to be tailored to the person.
Additionally, we have a fresh A-L-L initiative to incorporate cardiovascular hazard management to diabetes care. This states BG management is essential, but lipid management can also be crucial. Cardiovasulcar complications associated with lipid abnormalities are among the greatest killers of diabetics. A combo of medications can really aid: Aspirin, Lovastatin, Lisinopril.
We’re targeting each diabetic over 55 and those with different complications, such as hypertension or coronary artery disease, and putting them on those three meds, that are shown to reduce cardiovascular disease by 20-30%. We see enormous impact already, because the complications of large BG show up much later, however, the cardiovascular disease (heart attack, stroke) generally show up within a few years.
Beyond this, we also possess an excellent proactive system of patient reminders for your next pap smear, next mammogram, etc.
DM) Kaiser got pretty beat up recently in the kidney transplant scandal. How is it working to restore patients’ religion in its care?
MM) I have to admit that we didn’t deal with this well. There is some irony in the sense that the true transplant care was good, but we snapped it with all the administrative section. We failed to get patients moved on the new waiting list in order of their current seniority. So individuals ended up in limbo on the receiver list.
What are we doing about it? Phasing out the transplant program. We brought the app in-house because we thought we could do much better job. But we’re admitting defeat within this field.
What we’re understanding is that individuals can’t deal with this sort of program without a significant administrative overhaul. So we’re shutting down that program till we’re sure can we get it done correctly. We’re not giving up on kidney care, but going back to utilizing outside contracted surgeons to run the transplant, at UC Davis and UCSF (that is how we did it previously).
DM) Finally, Kaiser’s unique capitation system (members pay a predetermined amount per covered “mind” per month) makes some people today think they’re barred from utilizing Kaiser unless their employer is contracted with the company. What’s the chance for individuals already diagnosed with diabetes to join Kaiser should they prefer?
MM) Many of the individuals who enter KP do come as a member of an employee group — especially if they have a pre-existing chronic condition, as as part of a team, they don’t need medical screening to join.
Should you apply as an individual, you do need to go through screening. And you may be denied or have limitations placed on your coverage, meaning you might need to pay for some remedies out of your pocket. And to be honest, some people likely do get rejected out of hand. That is a fantastic reason why the majority of folks look to work for a business offering fantastic medical insurance benefits.
DM) Dr. Mustille, what is your message into the diabetes community?
MM) I just feel that Kaiser is a very good location for those who have diabetes. A coordinated, organized system is the perfect method to look after a complex condition like this. So I’d say, if you’ve got access to Kaiser, then you should make the most of it.
You won’t hear that from many other health plans — asking possibly expensive members to join… but I’d say we do quite a good job with diabetes and people should make the most of it whenever they could!
Thanks, Dr. M, for giving us the provider perspective; we will all be curious to observe how Kaiser recovers by the latest scandals along with resignations. Ugh.
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