It’s Not About The Box Improving Care at Group Health with People, Process and Technology

November 12, 2012

The New Normal

Filed under: Uncategorized — Matt Handley @ 2:51 pm

Ed Ellison MD, the Executive Medical Director of KP Southern California and Elliot Fisher MD from the Dartmouth Institute for Health Policy, worked together to set the context for a combined meeting of Primary Care leaders and Resource Stewardship experts throughout KP.  In beautiful Pasadena California.

The “New Normal” Ed Ellison referred to:

More members +Less revenue + political /Regulatory uncertainty + aggressive competition + Best at getting better = KP transformation

The only way there is a positive future is if we can take better care of patients with fewer resources.  KPSC is aiming to bend their trend by 1% by eliminating waste.  The commitment to Quality is unshaken.   The challenge to every set of chiefs is to be the best at getting better – identifying positive deviance (the few who have cracked the nut and figured out how to get better outcomes across the spectrum) and spreading those practices.  And doing this in a way that builds a vital professional practice, a thriving business and demonstrating that we can transform healthcare.

KPSC is committed to expanding capacity within existing resources – not more bricks and mortar, but meeting patients’ needs more flexibly.

Ed leads with quality, relentlessly.  Ed love quotes, and my favorite one from the talk:  “Wherever you go, go with all your heart” Confusius.

The conference then backed the satellite up with Elliot Fisher looking at things from a national level.  The picture is one that we are familiar with – health care is the reason that our deficits are ballooning nationally, and the reason that we are having to cut state budgets for basically everything besides healthcare.  It just can’t go on.  He walked through the lens of variation, the building blocks of the Dartmouth Atlas that Elliot Fisher and Jack Wennberg developed, include the standard three categories of variation – effective care, reference sensitive care and supply sensitive care.  Great simple descriptions of all of these.

The great relatively new insight that he brought was the “gray area” decisions about intensity of care.  The propensity to intervene (starting as simply as the check back visit frequency for HTN) is correlated to overall spending, and they are clustered regionally.  We miss this when we just look at variation in effective care, and in preference sensitive care.

Lets start with clarifying aims (better health, better care, lower costs), better information to support improvement and inform patients, new models (create systems of care), and realign incentives (both financial and professional).  That enables accountable care organizations, a strategy to try to create system of care from the current chaos.  There are now 230 of these nationally, and over 500 pending at CMS.  I think of them as Kaiser wannabes.

Many of Elliott’s identified best practices are from Group Health or KP, and those that aren’t mostly are done in our practices.  But it will take more.  It will take more than these – it will take reliably doing all of these everywhere, and it will take us working together to discover more ways to get to the 30% cheaper that the country needs.

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