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

October 16, 2008

Population Management Tools

Our team visited  three KP regions to better understand how we might address our needs for tools that support population management and care/case management.  As you may know, the leaders of the two operating divisions (Group Practice Division and Health Plan Division) have put forward their A3s for 2009, and there is a clear call for a tool to support population/panel management and chronic condition coding.

Our trips focused on several questions

  • What have the KP regions done to develop and implement tools for panel management?
  • What could we buy from them to implement for our organization/patients at GHC, with either a model of shared future development, or independent future development?
  • What can we learn to develop the tools ourselves?

The requirements for what we need to deliver for Group Health for panel/population management, stated broadly, include:

  • The ability to define populations by clinical characteristics, with the ability to edit patients into or out of the population
  • The ability to flexibly define gaps in care (both clinical and coding) and present that information at any time (including at the time of all interactions with patients)
  • The ability to flexibly identify patients by care gap as candidates for patient-centered outreach
  • Support patients that get their care in both the GPD and the network
  • Support reporting important clinical performance with fresh data
  • A data warehouse that meets both business and clinical requirements (real time data) – and I know – this is a part of a solution rather than a requirement…

Our team is reconciling all of the input and will be meeting to help inform organization decisions about buy/build and timelines.  It will be a stepwise process that we will approach using incremental gains, but hopefully one that can get started relatively soon.

October 10, 2008

KP Colorado’s population management tools

I am just back from leading a team to Kaiser Colorado to assess the toolset they have created to support their population management work.  This was the last stop on our road trip of different permanent groups, having been hosted by KP Northwest in KP Southern California recently.

We have a long history of collaboration with KP Colorado, which in many ways is a kindred spirit to Group Health.  We are about the same size, we both have some patients in contracted networks, and we both have a long history of innovation and sharing.  As expected, they were very well organized and generous with their time.

The backbone of the work Colorado has done is their data warehouse.  They are farther along than other Kaiser regions in developing a flexible and robust data warehouse (for geeks, they are far along towards having true Service Oriented Architecture, or SOA).  It turns out this is probably the most important aspect of any population management system- the ability to bring together different data elements to meet different clinical in business needs.  Our current system (which we are investing to improve) is not really a clinical data warehouse.  It’s refreshed monthly, a frequency this unacceptable for clinical care.   KP CO have organized their tool set in 3 distinct layers – the data layer, the rules engine, and a front end.  This provides flexibility in how data are used for different business needs.  it also makes it much easier to change clinical rules in having them built into the top layer.

Colorado was great about showing us both the “story for publication” (the power point and slick demo), and the “real dirt” (watching the tool in action in clinical teams).  they shared these they would do the work differently if they were to start over.

The cross functional team that went on the trips will organize the information about the 3 different tool sets and begin a discussion about “make/buy” based on our internal capacity and our clinical and business needs.  The  strategic deployment work in the business planning for 2009 that comes up next week will help prioritize the work.

October 2, 2008

POINT – KP Southern California’s everything to everybody application suite

Filed under: Care Management,Population management — Tags: , — Matt Handley @ 5:58 am

The second stop on our tour of KP population management tools was to Long Beach, the home of POINT, the set of tools developed by their Pharmacy Administrative Services group.   The team there in KP Southern California has produced an incredible array of tools to support the delivery of care to patients, with about 100 discrete applications sitting atop a database of gargantuan proportions.  The tools that have been built run the gamut from classic population management activities like registries, to supply chain solutions for pharmacy. The tools that have been built by this passionate group of people are incredible, and parts of their application suite are in use in all KP regions.  Think Archimedes – but instead of a long enough lever to move the world, think data.  They use it to impact all kinds of activities.  And their generosity in sharing what they have done was more than we could have asked for.

But enough about them – what about Group Health?  We went on this trip to understand what we could use to better support our patients and our business goals (buy/beg/borrow/steal/learn from…).  What we saw was both technically inspiring and a testimony to the importance to an investment in people, process and technology, working hand in glove on behalf of patients.  The Riverside medical center is a model for organizing around patients to support them in maximizing health outcomes and affordability.  They use the Point toolset to maximum advantage.

We have a lot to digest after visiting KPNW and KPSC.  Next week we visit KP Colorado to see their tool set.  Our intention is to gain enough understanding to set our own path for developing tools that can support our patients and our practice teams, from basic population management activities like HEDIS to supporting complex case management.  There are basically three possibilities:

•    Buy one of the KP solutions for use internally, and join the ongoing development effort for the tool
•    Buy one of the KP solutions as is, and then go our own way in development
•    Build our own solution, incorporating the best of the different KP solutions as possible.

Next week I’ll blog about the Colorado trip, and the next steps for making our investment.

September 10, 2008

The bake off – investigating panel management tools

Filed under: Population management — Tags: — Matt Handley @ 5:59 pm

I am in the airport about to fly to Portland to visit with KP Northwest to follow up on a recent visit to see what they refer to as their “Panel Support Tool” (PST), an application that helps fill the gaps that Epic leaves in managing a population of patients.

While Epic is the top electronic medical record available, it is encounter based – it helps us do a great job at visits, and coordinating care throughout our delivery system.  That is great as far as it goes (and it goes a long way), but optimizing the health of a population takes a lot more than that – we need to be able to look across our patient population to see what their gaps in care are and get a patient centered snapshot, even when they are not in the office.  Which patients in our panel who are candidates for ACE or statins aren’t on them?  Which patients will need to be seen for the management (and coding) of chronic conditions before the end of the year?  Epic just isn’t very good at that (despite years of working with Epic to try to get then to build that functionality).

We were the first group in the world to have online disease registries, but had some technical challenges (and resource restraints) that led to our current hiatus in effective tools for population management.  We have waited while other Permanente groups with deeper pockets have innovated with population management solutions, and are now ready to investigate bringing one of their solutions to Group Health, or at least learning from their efforts if we decide to develop our own.

KPNW’s tool is impressive.  It was developed in KPNW and KP Hawaii, and started humbly, with little resource and some very innovative clinical leaders.  Today we will visit with Rob Unitan, a pulmonologist/intensivist who has led the effort in Portland.  They have moved past having a stand alone tool, working to effectively integrate the PST with Epic.  On a prior visit we saw how the PST was integrated into workflow to identify and act on all care gaps (including HEDIS, other quality areas like ASA, ACE and statins, and chronic condition coding) at every visit, and how the tool is used to organize team based outreach.  Today we are flying down to look under the hood – to understand the technical aspects of the tool, and if it is feasible to adapt it to use at Group Health.  Jim Jackson, a guru programmer from ISD, and Emily Hull, our Director for Health Informatics who leads our Epic work from the GHC side are along for the tete-a-tete with the technical folks from KPNW.

Today is step one – we will be checking out the work of KP Southern California and KP Colorado in the next six weeks.  Our plan is to have enough information to include this work in budget planning for next year.

A presentation demonstrating the “Panel Support Tool” used in KPNW and KP Hawaii can be downloaded here:

KPNW Panel support tool

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