2015 Annual Meeting
May 3, 2015
Los Angeles, California
Operationalizing Telemedicine in
Managed Care: Lessons from
Kaiser Permanente
Half Day Course
Meeting Room 404AB
12:00 PM – 3:00 PM
Operationalizing Telemedicine in Managed Care:
Lessons from Kaiser Permanente
Half Day Course
May 3, 2015 –12:00pm – 3:00pm
Room 404AB
Creating and sustaining an effective, efficient and predictable telehealth program within the already complex care
delivery paradigm can be challenging and overwhelming. As the country moves from fee-for-service to value
driven reimbursement, Kaiser Permanente will share their strategy and lessons learned for operationalizing
telehealth into the managed care delivery model. This course will address how this organization leveraged a
variety of telehealth technologies and workflows to enhance and expand quality care, increase consumer
engagement and reduce healthcare costs. This course will provide a high level overview of Kaiser Permanente’s
Telehealth strategy with detailed learnings from a few select programs. Participants will learn about where and
how to incorporate telehealth into an established care delivery model and how to overcome adoption barriers
and select the right technology partners.
LEARNING OBJECTIVES




Understand where and how to incorporate telehealth into an established care delivery model
Identify critical success factors and challenges based on the type of program
Overcome adoption barriers across key stakeholders
Understand how to select the right technology partners
Agenda
Time
Topic
Who
12:00 – 12:10
Introduction & Overview of Kaiser Permanente
Madhu Narasimhan
12:10 – 12:30
The Landscape of Virtual Care
Bill Marsh, MD
12:30 – 12:50
12:50 – 1:10
Video Visits: Outpatient/Home Settings
KP Southern California
KP Mid-Atlantic States – Leveraging Resources
across Departments and State Lines
Tadashi Funahashi, MD
Dennis Truong, MD
1:10 – 1:35
Break Out Session
1:35 – 1:45
Break
1:45 – 2:15
Video Visits: Inpatient Setting – Telestroke
Jo Carol Hiatt, MD, MBA
2:15 – 2:35
Patient-generated Health Data
Mark Groshek, MD
2:35 – 3:00
Q&A
All
Operationalizing Telemedicine in Managed Care:
Lessons from Kaiser Permanente
Course Faculty
Madhu Narasimhan, Vice President, Virtual Care & Analytics, Kaiser Permanente
Information Technology (Moderator): Madhu Narasimhan manages teams in the
areas of care delivery telehealth, information analytics, health information
exchange, clinical informatics, emerging technologies, and clinical contact center
systems. Madhu joined Kaiser Permanente in 2002, served in various
management positions, and became a vice president in 2010. Madhu has more
than 20 years of experience in software development, project/program
management and application delivery experience.
Tadashi Funahashi, MD, Chief Innovation and Transformation Officer; Assistant
Regional Medical Director, Kaiser Permanente Southern California: Tadashi
Funahashi, MD joined Kaiser Permanente Southern California Region, Orange
County in 1992, and maintains a busy clinical practice in orthopedic surgery. He is
the Chief Innovation and Transformation Officer and Assistant Regional Medical
Director for Kaiser Permanente Southern California. Dr. Funahashi also founded
and chairs the National Implant Registry Committee, and is a clinical professor of
orthopedic surgery at University of California Irvine College of Medicine. He
earned his medical degree and completed his orthopedic residency at UCLA
School of Medicine, and then joined the faculty at the UCLA Department of
Orthopedic Surgery prior to joining Kaiser Permanente.
Mark Groshek, MD, Medical Director, Digital Services Group, Colorado
Permanente Medical Group: Mark Groshek joined the Colorado Permanente
Medical Group in 1989. He practices pediatrics in Colorado, and has been part of
the Kaiser Permanente Health Connect Team in Colorado since 2004, serving as
the Colorado physician lead for kp.org, Kaiser Permanente’s patient web portal.
Since June 2013, he has been the Medical Director for Digital Services Group,
where he continues to work to ensure that Kaiser Permanente members have
easy access to their own information and to their health care teams via kp.org.
Communicating with his patients and their families and providing care through
kp.org has been an important part of his practice, and he is especially interested
in finding more and better ways to gather important member health information
outside of Kaiser Permanente offices, to make that information easy to
understand and act upon, and to provide more care to our members when and
where they need it. He has become an expert on the special challenges with
EMRs in honoring teen confidentiality, and published an article in 2012 outlining
these issues.
Jo Carol Gordon Hiatt, MD, MBA, Chair, National Product Council; Assistant
Medical Director, Southern California Permanente Business Administration: Dr.
Hiatt is Chair of the National Product Council for Kaiser Permanente and also
chairs KP's Inter-Regional New Technologies Committee. She is a partner in
Southern California Permanente Medical Group (SCPMG) and is currently
Assistant Medical Director, SCPMG Business Management. Dr. Hiatt chairs
Southern California's Technology Deployment Strategy Team as well as the
Oversight Committee for Integrated Medical Imaging. Dr. Hiatt joined Kaiser
Permanente as a general surgeon at Panorama City, later serving as Chief of
Surgery at that location and member of the SCPMG Board of Directors. She
received her undergraduate degree from Stanford University and her medical
degree from Duke University, and trained in general surgery at UCLA. In addition
to her clinical degree, Dr. Hiatt received an MBA from UCLA's Anderson School of
Management. She was designated an American College of Surgeons Health Policy
Scholar in 2013.
Bill Marsh, MD, Vice President and Chief of Staff, Colorado Permanente Medical
Group: Bill Marsh, MD functions as the VP & Chief of Staff for the senior executive
team and the Colorado Permanente Medical Group. He is involved in all areas
related to the member experience and service excellence. He also is involved in
new technologies, including digital and mobile applications, telemedicine, and
telehealth, both locally and nationally. He co-leads the national Kaiser
Permanente Virtual Care Workgroup. He graduated from the University of Texas
Medical School in San Antonio and completed his pediatric residency in Oklahoma
City at Children’s Hospital and a fellowship in both allergy/immunology and
pediatric pulmonary medicine at National Jewish Hospital in Denver. He was in
private practice for five years before joining Kaiser Permanente.
Dennis Truong, MD, FACEP, Emergency Medicine Physician; Telemedicine
Director, Physician Lead for HouseCalls, Kaiser Permanente- Mid-Atlantic States:
Dr. Truong joined MAPMG as an Emergency Physician in 2010. He helped with the
genesis and development of Kaiser Permanente’s 5 regional Clinical Decision Units
(CDU) and is a Physician Lead for the Call Center. As the region’s Telemedicine
Director since 2014, one of his accomplishments was pioneering the Kaiser
Permanente CDU Video Visit program, an innovative 24x7 telemedicine option for
low-acuity medical conditions. The accomplishments of this program have been
featured in The Washington Post, Modern Healthcare, a Verizon video and news
blog, and won The Daily Record “Innovator of the Year” award.
Operationalizing Telemedicine in Managed Care:
Lessons from Kaiser Permanente
Operationalizing Telemedicine in Managed Care:
Lessons from Kaiser Permanente
As you come in, please find a seat and fill
out the worksheet at the middle of each table
which will be collected before we begin
today’s session.
Today’s Agenda
Introductions & Overview of Kaiser Permanente
Madhu Narasimhan
The Landscape of Virtual Care
William Marsh MD
Video Visits: Outpatient/Home Settings
• KP Southern California
• KP Mid-Atlantic States – Leveraging Resources Across
Departments & State Lines
Tadashi Funahashi MD
Dennis Truong MD
Break Out Session
Video Visits: Inpatient Setting : Telestroke
Jo Carol Hiatt MD, MBA
Patient-Generated Health Data
Mark Groshek MD
Q&A
3 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Overview of Kaiser Permanente
Madhu Narasimhan, Vice President, Virtual Care & Analytics,
Care Delivery Business Information Office, KPIT
4 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Kaiser Permanente
integrated
Northwest
9.6 million members
17,000+ physicians
Northern California
49,000+ nurses
Colorado
Mid-Atlantic
Southern California
Georgia
192,000+ employees
8 states + District of
Columbia
38 hospitals
Hawaii
600+ medical offices
$56.4 billion operating
revenue
Nation’s largest not-for-profit health plan
Scope includes ambulatory, inpatient, ACS, behavioral health, SNF,
home health, hospice, pharmacy, imaging, laboratory, optical, dental, and insurance
Telehealth in the (near) future…
TELEHEALTH
Using digital technologies to deliver medical care, health education, and
public health services by connecting multiple users in separate locations.
20%
to 30%
OF MEMBER
APPOINTMENTS
COULD HAPPEN
IN ALTERNATIVE
NON-FACE TO
FACE VENUES
BENEFITS
•
•
•
•
•
•
Timesaving, convenience
Decreases CO2 emissions
Fewer medical buildings needed
Increased consumer satisfaction
Expanded access to timely care
Increased workplace productivity
Kaiser Permanente’s Mission
To provide high-quality, affordable
health care services and to
improve the health of our
members and the communities
we serve.
7 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
The Landscape of Virtual Care
William Marsh MD, Associate Executive Director
Government Relations and Care Delivery IT
The Permanente Federation
8 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Health Care is Unfrozen: Why Now?
What does this mean?
9 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
“Spread health to all…
we meet people where they are.”
10 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Virtual Care Work Group:
Recommendation for Kaiser Permanente
Top
Populations
Virtual Care Tools to
Scale Program Wide
Healthy
Video Visits
Low Utilizing Millennials
Acute
Respiratory, Minor Injury,
Muscular- Skeletal, Dermatology
Chronic
Diabetes
Transitions
Hospital to Home
End of Life
Palliative, Hospice
11
April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Web Chat & Text
Self Triage w/ Intelligent Routing
Member Generated Data;
Questionnaires & Remote Monitoring
Social Networks
Video Visits between clinics & to home
12 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Telestroke
13 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Web Chat
14 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Self Triage, with intelligent routing
Intelligent
Routing
15 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Member Generated Data
Questionnaires
16 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Patient Self-Monitoring
Drivers of Health
Personal Behaviors
40%
Family History and
Genetics
30%
Environmental
and Social
Factors
20%
Source: McGinnis et al, Health Affairs, 2002
17
10%
Medical
Care
Social Networking
Self Managed
Health Care
Support
Social
Media
Confidence
18 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Knowledge
Skills
Please note questions on paper and we will collect and review them
during the Q&A at the end of today’s session.
Video Visits: Outpatient/Home Settings
Kaiser Permanente Southern California
Tadashi Funahashi MD
Chief Innovation & Transformation Officer
Asst Regional Medical Director, Health Innovation & Process Transformation
Southern California Permanente Medical Group
20 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Integrated Video Visits Background
The Integrated Video Visit (IVV) Project enables members to have a scheduled video visit with a
Kaiser Permanente physician from their personal computer or mobile smart device
(phones/tablets).
Benefits
Members can receive care without having to go to a
Kaiser Permanente Facility
Advantages
 Expanding traditional face to face appt. model.
 Additional products to meet member’s needs and
compete in health care market.
21 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Integrated Video Visits Impact
Service – Increase convenience for members and offer alternatives to traditional
face-to-face visits.
Access – Make virtual appointments more readily available for Primary Care and
specialty.
Quality – Improve outcomes when members receive more timely care.
Affordability – minimize unnecessary ED/UC visits ; maximize use of in-network
and specialty resources; reduce travel for patients
22 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Integrated Video Visits Technology Features
• A third party platform is used for video visits
and has been integrated with the KP EHR,
website, and mobile app.
• The video visits will be scheduled through the
call center or physician’s back office staff.
• Providers are able to view video visits on their
schedule, launch video visits from their
schedule, and document in KP’s EHR while in
a video visit.
• Members will be able to launch visits from the
KP website or the KP flagship app and then
review their AVS online.
23 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Integrated Video
Visit
Members
Launch from
KP website
or mobile
app
Clinician
Schedule &
launch from
KP’s EHR
IVV Interface Screenshots
Patient Using PC
Our Provider EHR Interface
Patient Mobile Device
Provider Using PC
Provider Mobile Device
Key Lessons Learned
• Training: Valuable to give demo/training to all providers. All providers need training on
video visit functionality, EHR documentation, using new hardware (camera, headset, etc.)
• Mobile Devices: Based on preliminary findings, higher success rates when patients use
mobile devices (vs patients using a PC)
• Readiness: Department Chief go-live before entire department training helps anchor and
facilitate leadership to ease use of IVV with potentially anxious department providers.
• Local Team: Support structure includes the Chief / Physician-in-Charge,
DA/ADA/Supervisor, Project Manager, back office staff, local IT, local EHR support, local
Call Center
• Weekly Project Manager Meetings: with medical center Project Managers helps
communication best practices and share learnings
25 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Please note questions on paper and we will collect and review them
during the Q&A at the end of today’s session.
Video Visits: Outpatient/Home Settings
Leveraging Resources Across
Departments & State Lines
Dennis Truong MD
Telemedicine Director, Physician Lead for HouseCalls,
Kaiser Permanente, Mid-Atlantic States
27 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
KPMAS—Three Jurisdictions: Maryland,
Virginia, DC
Members hailing from Six States
580,395
Members*
*As of 2/28/2015
Clinical Decision Units & Urgent Care:
After-Hours, Acute Care Services
Gaithersburg
South
Baltimore
Tysons
Corner
Capitol
Hill
Largo
5
Across the Mid-Atlantic States:
29 KP Medical Office Buildings
109
Miles
29
82
Miles
We’re #1!!! In Traffic Congestion
…The
Beltway
Working
9 to 5
Reinventing the “House-Call”: KP Video Visits
since August 2013
Electronic Medical
Records
Emergency Physicians:
supporting Call Center dispositions and
regional resource utilization
Dr. Truong
Dr. Becerra
Dr. Carney
Dr. Do
Dr. Johnson Dr. Campbell Dr. Matthews Dr. Nicoll
Dr. Patel
Dr. Austin
Dr. Crismon
Dr. Zarrabi
KP Call Center:
triage and direct patients, guided
by Scripts and Protocols
Necessity is the Mother of Invention
Each Challenge is
an Opportunity
What If…
Delivering on the Triple Aim
& Providing an Ideal
Patient Care Experience in
the Face of Access
Constraints
…We Could Grow Our
Region Virtually, Offering
Convenient Solutions to
Patients Not Requiring an
In-Person Visit
Not Reinventing
the Wheel
Leveraging Existing
Resources to Build a
Seamless Remote Care
Experience for Our Patients
Call Center
Staff
CDU-to-CDU
Partnerships
“HouseCalls”
is Born
Call Center Scripts
and Protocols
KP Emergency Medicine
Physicians
Integrated Care Delivery and
EMR, Leader in Technology
Telemedicine: Care Along the Entire Spectrum
Chronic
Care
Adult
Primary
Care
Pediatric
SubSpecialties
General
Pediatrics
Behavioral
Health
Health
Maintenance
“House
Calls”,
CDU-toCDU
Acute
Care
Primary
Care
Specialty
Care
Virtual Visits Offload the Busiest CDUs
Before CDU-to-CDU
Telemedicine
South
Baltimore
Largo
Patient with straightforward
UTI symptoms arrives at
Largo CDU—our busiest
CDU—at peak hours,
anticipating an extended,
uncomfortable wait
Cart complete
with virtual
otoscope,
stethoscope
After CDU-to-CDU Telemedicine
• South Baltimore physician is
less busy and sees that Largo
CDU is very busy via the Wait
Time Dashboard
• Physician coordinates with
Largo RN to activate CDU-2CDU to virtual help Largo
volume
• Physician reviews patient’s
chart, orders UA, and
expedites UTI diagnosis and
antibiotic for pick up by patient
at Largo pharmacy
 Pilot with Passion and a Purpose
 Be efficient, leveraging your
existing resources
 Solve a problem without creating
bigger problems
 Play the perspectives
 Do the right thing
Please note down any questions on paper and we will collect and
review them during the Q&A at the end of today’s session.
Breakout Session
Topics for each table will be announced.
Tadashi Funahashi MD, Chief Innovation & Transformation Officer, Southern California Permanente Medical Group
Mark Groshek MD, Medical Director, Digital Services Group, Colorado Permanente Medical Group
Janis Ground, PT, MBA, Project Manager Virtual Care, Colorado Permanente Medical Group
Jo Carol Hiatt MD, MBA, Assistant Medical Director, Southern California Permanente Medical Group
William Marsh MD, Associate Executive Director, The Permanente Federation
Madhu Narasimhan, Vice President, Virtual Care & Analytics
Angie Stevens, Telehealth Executive Director, Virtual Care & Analytics
Dennis Truong MD, Telemedicine Director, KP-Mid Atlantic States
40 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Video Visits:
Inpatient Setting - Telestroke
Jo Carol Hiatt MD, MBA
Chair, National Product Council, Assistant Medical Director
Southern California Permanente Medical Group, Business Administration
41 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Telestroke Care Kaiser Permanente Southern
California
 Background
 Implementation
 Data
 Quality Review Process
 Recommendations
42 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
What is Telestroke?
 Provides the ability to rapidly assess individuals with acute neurological deficits for tPA
candidacy using a two-way video tele-conferencing system
– Proven through clinical trials to allow for more accurate administration of tPA than
telephone consult.
 Program Goals:
– Improve acute stroke patient outcomes
– Increase appropriate tPA administration rates
– Provide timely consults for our patients 24/7
 In Scope – patients presenting to the EDs
– Any patient with an acute neurological deficit suspicious for stroke, no greater than 4.5
hours since last known to be normal.
43 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Technology
Telehealth cart and
peripherals in ED
Neurologist uses laptop and
camera remotely
44 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
Background
 Received formal approval to launch internal coverage solution (using SCPMG
neurologists) region-wide in Dec 2013.
– Quality Committee approved pilot for 1 year starting May 2014
 KP Telestroke is live in 11 of 14 EDs
– Live: Anaheim, Baldwin Park, Downey, Fontana, Irvine, Ontario, Panorama City, South Bay,
West LA, Woodland Hills, San Diego
 Moreno Valley and Riverside are utilizing Specialists On Call (SOC) for this service.
Had pre-existing contract prior to regional program launch and Region wanted to
stabilize prior to incorporating these sites.
 Los Angeles neurologists must be available for residency program. Attending
neurologists utilize Telestroke to oversee residents.
 Currently 8 tele-neurologists
– Daytime coverage (7a-7p) provided by all vascular neurologists
– Evening (7p-7a) and weekend coverage provided by a mixture of vascular and general
neurologists (who have met minimum educational requirements to participate in the program)
Implementation
 Prior to go-live, implementation consisted of:
– In-person kick-off meeting with all local stakeholders
– Equipment training for ED staff
– Mock code strokes to allow familiarity with Avizia clinical assistant, as well
as train the nursing staff on how to help perform the neurological
examination with the tele-neurologist
 Following go-live
– Debrief calls to troubleshoot issues and streamline processes occurred
every 2 weeks initially, followed by monthly calls
– Follow-up has been demonstrated to improve and maintain shorter door to
needle times
46
tPA Data and Door to Needle Time
 Pre/Post Telestroke Data up to 9/30/2014 for a parallel comparative time
period of 13 months (10 medical centers):
47
Pre Telestroke
Post Telestroke
# pts given tPA
47
84
tPA ≤ 60 minutes
15.9%
52.3%: p <0.05
Mean DTN
91.3 min (SD 30.8)
71.3 min (SD 31.5)
Median DTN
82 min
(IQR 66.5-115.0 min)
63 min
(IQR 54.8-78.3 min)
p=0.0006. Abs diff 19
min
Quality Review Process
 Each general neurologist has their first 5 cases reviewed by a vascular
neurologist to ensure quality of care.
 After review of the first 5 cases, each general neurologist has one case
per month reviewed.
 All neurologists participating in telestroke will have one case reviewed
at each center by the local center Chief of Neurology.
48
Feedback from our ED Physicians
This is a cutting
ED MDs highly
satisfied
with service quality
edge program that has established
Woodland Hills as a leader in stroke care in the area
I would bring my family here
The program has been a
if they were suffering from a possible stroke
game changer
… caliber/commitment to quality of the team has
improved our Stroke care tremendously.
This program has gone
above and
beyond our every expectation
49
…program has revolutionized
how ED's provide critical time-dependent care.
Feedback from our ED Physicians (cont.)
“The telestroke program has improved the care for stroke patients at WLA tremendously.
Similar to a STEMI, early recognition and expediting treatment are keys to improving patient outcomes and
decreasing morbidity; however, given the wide ranging presentation of symptoms of CVA patients,
recognizing the need and expediting the delivery of tPA for qualified patients had been
challenging. Lack of readily available neurology and neurosurgery consultants, differing opinions regarding
benefits of tPA, and limitations of telephone consults had further added to treatment delays for CVA patients.
The telestroke program has overcome all these factors. Dr. Sangha and Dr.
Ajani have been readily available to the WLA ED via the telestroke program – often evaluating patients via
tele-medicine within minutes of patients’ arrival to the ED with CVA symptoms. The decision for tPA
administration is now appropriately placed with a dedicated group of stroke
neurologists, who are intimately familiar with the benefits and risks of such treatment. Lastly,
Dr. Sangha and his group have also provided tremendous support for patients who developed hemorrhagic
complications after receiving tPA. Overall, the telestroke program have improved the care for CVA patient at
WLA tremendously. It has been great to see our organization embrace technological
advances, such as telemedicine, for patient care. “ West Los Angeles
50
Please note down any questions on paper and we will collect and
review them during the Q&A at the end of today’s session.
Patient-Generated Health Data
Mark Groshek MD
Medical Director, Digital Services Group
Colorado Health Connections Physicians Leads Team
52 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.
The Big Idea
The Challenge
The Gap
Key Questions
Health conditions
could be more
effectively co- or
self-managed with
information and
data provided by
patients
themselves.
If we are to improve
value to consumers
of health care it is
critical that we
enable them with
tools to capture, use
and share data
pertinent to their
health condition.
Can we seamlessly
integrate patient
information into
care processes in a
way that enables
individual treatment
decisions and
improved outcomes,
regardless of where
the patient is?
What is Patient (Member) Generated Data?
Member role in data generation
Applicability to patient health
Non-transactional health data is considered MGD:
▪ Health history, symptoms, biometric data, treatment
history, lifestyle choices, and other information that is
▫ Created, recorded, gathered, or inferred by or from
Health
related
Membergenerated
Collected data

patients or their designees
To help address a health concern1
Clinical transaction data is not MGD:
• Data entered as part of a care encounter
• Data entered into secure emails with clinicians as free
text
Not healthrelated
Non-member
generated
▫
Qualifies as
MGD?

• MGD does not include:
– Health plan data, data entered into forms
– Member registration information

• Data generated prior to enrollment by non-members is

not MGD
1 Office of the National Coordinator (ONC) for HIT, Consumer Empowerment Workgroup. July 2013
How is the data generated?
 Active
– when the member (or their designee) reports it themselves
 Passive
– captured by a remote device (e.g. blood pressure recording, fitness device,
etc…)
– indirectly captured (e.g. usage patterns or affiliations on social networks)
Proactive Assessment of Total Health &
Wellness to Add Active Years (PATHWAAY):
A comprehensive care delivery strategy for seniors receiving primary care
Components:
– Total Health Assessment (THA)
– KP.org/Clarity + Health Trac results
processing and scoring
– PATHWAAY MA/RN team outreach
calls for identified risks, prior to Annual
Wellness Visit
– Personalized Prevention Plan (PPP)
– Patient-centered office visit
A new workflow integrated into existing
office workflows
56
PATHWAAY Workflow
In Clinic
Provider reviews PPP
letter and Support Team
note, acts on the
information and/or
encourages follow-up
with appropriate health
care staff
Prior to office visit
Initiate THA collection via KP.org or
IVR when the visit is scheduled
Collaboration:
Provider hands
member the printed
PPP
Prior to Office Visit
THA responses scored, PPP letter created
in EHR, and positive triggers referred to
support team
In Clinic
Staff in clinic see message on schedule
to “print PPP” and any other pre-visit
needs (Orthostatic BP, PVR, Adv
Directive book, etc.)
Patient-centered Care
Region-wide Implementation
July 2012 – February 2015
 56,133 Annual Wellness Visits
completed
 48,482 THAs completed
– Roughly 1/3 each via kp.org, IVR,
and in office
“The PPP provokes conversations
that might not happen - like falls,
depression, incontinence - because
the patients don't normally bring these
up on their own.”
KPCO Internal Medicine Physician
58
.
 >23,500 RN outreach calls
have been made to patients
with risk responses on the THA
VALUE of AWV – Increased Identification & Addressing of Risk Factors
 Nearly everyone who triggered positive for a particular condition reported discussing the health
condition with the PCP during the AWV.
 Many members (one-third to one-half) reported discussing these conditions with the PCP,
even when the member did not “trigger” positive, inferring a preventative approach in
identifying and addressing possible risk factors.
% of Respondents By Positive Trigger
and % Discussing Condition with PCP
100%
94%
N = 74
92%
90%
80%
80%
78%
75%
60%
40%
N = 89
25%
22%
20%
5%
5%
5%
3%
0%
Falls
Pain
Urinary
Incontinence
% Triggering Positve for Condition on MTHA
*Anxiety & Depression were reported as one trigger in the member database
59 April 20, 2015
|
© Kaiser Permanente 2010-2015. All Rights Reserved.
Anxiety*
Depression*
Frailty
% Positive Trigger Discussing Condition w/ PCP
Personalized Prevention Plan (PPP)
BOTTOMLINE
 Most members recall receiving a PPP and found it easy to understand.
 Members, in general, keep their PPP and half had referred to it after their AWV.
 Members, in general, believe the PPP is valuable.
% “Yes”
78%
N = 119
60 April 20, 2015
|
© Kaiser Permanente 2010-2015. All Rights Reserved.
14% Ext Val
52% Valuable
N = 79
Impact of PATHWAAY Experience on Awareness &
Confidence
 Participating in the PATHWAAY program resulted in an increased awareness
of the actions to take to improve health.
 Participants also reported high confidence in their ability to make changes
that would improve their health.
N = 254
61 April 20, 2015
|
© Kaiser Permanente 2010-2015. All Rights Reserved.
Impact of PATHWAAY on Self-Reported Action
to Improve Health
62 April 20, 2015
|
© Kaiser Permanente 2010-2015. All Rights Reserved.
Impact of PATHWAAY on Outcomes
 Attendance at the balance class and incontinence class increased
after the classes were recommended based on the results of the
THA - attendance at the classes have been sustained.
 There has been an increase in diagnosis and treatment of
depression and anxiety among seniors since the PATHWAAY
program was implemented
 Performance on the Medicare Health of Seniors (HOS) outcome
screening has improved for falls and incontinence
 More detailed outcomes study is in process
63 April 20, 2015
|
© Kaiser Permanente 2010-2015. All Rights Reserved.
Keys to Success
 Patients are offered a choice of ways to complete the questionnaire
digitally
 A new workflow was designed to support existing office workflows
 A supporting staff infrastructure was built to support the new
workflow
 The information supplied by patients is actively used to engage
patients and help improve their health
 The entire process augments the relationship between the patient
and their PCP
Still Working On . . .
 Better integration with the EHR
 Improved tools to automate production of the
Personal Prevention Plan based on patient answers
Remote Monitoring enabled by Interchange:
Diabetes Management tool-kit
 Current state: diabetes care managers use regular
telephone outreach to help bring patients with out-of-control
diabetes into control. Glucose readings are manually
transcribed during the call
 Goal: upload glucometer result digitally into a system to
make it available to diabetes care managers and patients at
the same time
 Hypothesis: diabetes care managers will require less time
to provide care via telephone and so will be able to serve
more patients
Remote Monitoring enabled by Interchange:
Diabetes Management tool-kit
Glucometer
Desktop Application –
My Link
Each member is assigned
a glucometer device.
A CD to install the My
Link desktop application
The member uses the
glucometer device to take
his/her blood glucose
readings.
The patient installs this
My Link desktop
application on hi/her
personal computer.
The patient needs to
connect his glucometer to
the USB of his PC to be
able to automatically send
all his readings to the
Kaiser physician.
Portal for patients
Portal for Providers
A patient dashboard for
member access
A provider dashboard for
the physicians
The patient logs into the
patient portal to view all
readings sent to Kaiser.
The physician views all
patients in the pilot.
He/she views graphical
representation of the
readings along with
many great features to
help them track their
diabetes.
They can also view the
individual reading of the
patients thus using that
information to help out
the patients in a timely
and efficient manner.
The Nurse and the patient connect every week
to go over the readings and the graphs
The Nurse at her Desk at a Kaiser facility
The Member at his/her home
The nurse is able to view the readings of
her patients on the web directly.
The patient logs in with member id and
password and observes his readings.
She does not need to manually record the
readings anymore.
He no longer needs to spend hours narrating
the readings to the nurse.
Her readings are updated immediately
upon the patient uploading their data
He also observes the various graphical
representations of his progress that highlight
his progress and encourage him to keep
on track.
She can cut and paste the patients readings
directly into EHR
68
April 20, 2015
Self-Tracking Affects Outcomes:
A1C Pre Vs. Post of Engaged Members (1.6 avg decrease)
Figure 1: Graph View
 We tracked A1C of the 14 most engaged patients over the course of the pilot.
 Figure 1 (Graph View) shows that A1C of all the patients came down after 3 months as compared to when
they started the pilot, and the average A1c for the 14 patients reduced from 9.8 to 8.2 over the duration
of the pilot.
Remote Monitoring Improves Efficiencies:
Average Call Time – Pre v/s Post
31.7% decrease in call time
 Note – A few users had call time similar to the pre pilot phase, as they now
spent more time getting tutored from the providers.
Alerts/Data Visualization Changes Behavior:
No of Critical and Non-Critical Notifications during pilot
The notifications go
a long way in letting
the diabetic patient
know about what is
“not right”.
Legal Issues
 What is the expectation of the care team to respond to results
that are out of range?
– Data upload frequency varies from daily to just before scheduled
call—alerts triggered when data is uploaded, so not available in real
time
– As part of normal practice, patients have been educated about how to
respond to out of range values
 Terms and conditions specified that patients are responsible to contact
Diabetes Care Manager when they receive an alert. If not already
contacted, DCM does contact patient when they received an alert
Legal Issues
 Data that is used to make or change a medical
decision should be part of the electronic medical
record
 For now, this means copying and pasting data
and/or curves from the Diabetes Care System into
care notes in the EHR
Keys to Success
 It is easy for patients to upload their data
 Presenting the data back to patients as easily understandable
information helped them improve their self care
 The data flows to the people in the right job role—not
everything needs to land with doctors
 The tool augments the personal relationship patients have
with their care manager
 Patients continue to have responsibility for understanding and
managing their data and their health, and this tool helps them
do it more effectively
Still working on . . .
 Need an enterprise platform for receiving device generated
data, compatible with multiple devices, or with data
aggregators
 Integration into EHR
Please note down any questions on paper and we will collect and
review them during the Q&A at the end of today’s session.
Q&A
Please hand in all questions.
77 April 20, 2015
|
© 2015 Kaiser Foundation Health Plan, Inc. For internal use only.