February 28, 2012

Foreign health planners seek to understand Kaiser Permanente model

Molly Porter, director of KPI

Happy KPI program participants from the U.S. Army

The 1990s brought much debate about how to improve health care in the U.S., Europe and in far flung locations across the globe. So it wasn’t too surprising that many countries showed a strong interest in studying Kaiser Permanente as a successful model for preventive and cost-effective health care.

Across Kaiser Permanente, many health plan and medical group leaders have for decades participated in international organizations and spoken at conferences around the world, occasionally accepting brief consulting engagements.

However, in 1996, a new initiative emerged as Kaiser Permanente International (KPI), not to be confused with the 1964 to 1975 agency called Kaiser Foundation International (KFI).

Again, 21 years later, KP set itself up to share its secret sauce with health planners everywhere. Again, a nonprofit subsidiary organization was established with the goal of being self-supporting.

During its early years, KPI ran consulting projects abroad, including multiyear projects in Russia and South Africa. However, as consulting activity slowed, and interest in visiting Kaiser Permanente grew, KPI transitioned to offering primarily educational programs in our regions.

Since 2006, Molly Porter has been the director of Kaiser Permanente International and, since 2008, KFHP/H Senior Vice President Ray Baxter has served as president. Porter is a longtime KP communications professional who produced beautifully readable employee and member publications for the health plan for many years.

Today, she develops KPI's educational programs and has a small staff that includes Manager Joy Lewis, LCSW, MPH, who is based in Washington, D.C., and shared with Kaiser Permanente's Institute for Health Policy, and Program Coordinator Christine Aguilar.

Occasionally, KPI’s faculty and staff travel abroad to give speeches or short seminars on the Kaiser Permanente model. More often, foreign governments and health care organizations send health care leaders to California and Washington, D.C., to participate in KPI's programs, which include presentations by Kaiser Permanente’s most knowledgeable leaders.

British study generates renewed interest in KP

Illustration on cover of British Medical Journal, January 2002

Porter says interest in studying Kaiser Permanente’s operations has surged in the years since 2002 when the British Medical Journal carried an article about a study comparing Britain’s National Health Service (NHS) to Kaiser Permanente’s California health plan.

Titled "Getting more for their dollar: A comparison of the UK's NHS with California's Kaiser Permanente," the report stated that Kaiser Permanente members experienced more comprehensive and convenient primary care services and more rapid access to specialist services and hospital admissions than patients of NHS while KP's age-adjusted acute hospitalization rates were about a third of those in the NHS.

The report concluded that Kaiser Permanente achieved these results through: 1) more efficient use of hospitals; 2) integration (providing a comprehensive range of care services at each medical center); and 3) use of information systems.

A group of Brazilians from a private health plan participated in Kaiser Permanente International's September 2011 program.

In recent years, health leaders from 43 countries have participated in KPI programs. (Many of these countries were customers of Kaiser Foundation International between 1960 and 1975. See previous blog: posted February 27.) Among the countries sending the most participants are Brazil, Canada, Denmark, the Netherlands, Norway, Singapore, and the United Kingdom.

Porter says visitors want to learn about how KP members get all their care through one system of providers and services — doctors, nurses, pharmacy, laboratory, hospital, X-ray, surgery and home care. They want to learn about KP’s high-tech capabilities to store and distribute medical data, to share online medical records with members, and to conduct research to develop and share best clinical practices.

Foreign visitors are amazed at what they learn about Kaiser Permanente. They are wowed by how much access KP patients have to their medical information, Porter says. They are especially interested to learn that KP members can email their doctors and view their lab tests as soon as they are available to doctors. “They can’t imagine that,” Porter said.

Visit to Oakland KP inspires Danish health leaders

KPI Manager Joy Lewis, LCSW, MPH, is based in Washington, D.C.

Guests are also surprised to learn that Kaiser Permanente physicians receive regular feedback on their performance, she says. Recent Danish visitors found it odd that Permanente doctors aren’t allowed to have second jobs with other health facilities, as is common in Denmark.

In a 2010 letter to employees discussing the value of foreign leaders’ visits to KP, CEO George Halvorson included a link to Danish Medicine, which carried an article about the Danish Health Minister’s educational experience in Oakland.

In an article titled “Minister pa inspirationstur hos Kaiser Permanente,” which roughly translated means “Health Minister gets inspiration from Kaiser Permanente,” appeared shortly after the group’s visit.

The second paragraph gave a Danish nod to KP hospitality: “Molly Porter (KPI director and host) stands ready with a handshake and a personal welcome to each of the Danes,” the online newspaper article read. “(We are) on the 22nd floor of Kaiser Permanente headquarters in Oakland, California. In the background there is the prospect of the San Francisco skyline on the other side of the Bay.”

Christine Aguilar, KPI program coordinator

The article addressed the positives of Kaiser Permanente’s delivery of care, including the emphasis on disease prevention and how doctors don’t order superfluous tests and treatments.

“It is exemplary, not to make money on the number of operations. You earn the most money if you can avoid to operate, and to keep patients healthy. So the tendency to treat, as we see in the United States (is not the practice) at Kaiser Permanente,” Danish Health Minister Bertel Haarder is quoted as saying.

Emulating KP can improve quality

The Danish newspaper also covered a one-year study comparing Kaiser Permanente and the Danish system of care. Conducted by Danish physician Anne Frolich who was on the 2010 visit, the study concluded: “We can learn a great deal from the American Health Organization (Kaiser Permanente) on a number of points. . . An independent study has shown that Kaiser Permanente is 17 percent cheaper than its competitors in the United States and 117 percent better when measuring clinical quality,” she told the newspaper.

Frolich said she believes that a part of Kaiser Permanente’s success is due to pressure from other health providers in Northern California. “The only way Kaiser (Permanente) can survive is to keep themselves fantastically good,” she is quoted as saying.

This group of Danish health leaders visited KP's Colorado Region.

In another article, Frolich said: “Our analyses indicate that we will be able to deliver more cost-effective health services and possibly also better quality if we learn of their (KP) model.” She said her study compiled data collected from 1,000 physicians and other practitioners in Denmark.

KPI sponsors a three-day program titled “Learnings from the Kaiser Permanente Model” twice a year, often in the San Francisco Bay Area. These programs can accommodate 60 participants.

Two-day sessions for 20 to 30 participants may also be scheduled in our Southern California Region and at our Center for Total Health in Washington, DC.

KPI charges fees for its educational programs, as it is a self-supporting nonprofit subsidiary not funded by Kaiser Permanente members. Staffers and their KP colleagues also regularly meet with international guests for one- or two-hour meetings at no charge.

Educational visits to Kaiser Permanente often include tours to patient care facilities where foreign health leaders can see the integrated system of care up close. As Danish Medicine reported, Health Minister Bertel Haarder “was lucky enough to get a tour (of the ultramodern Garfield Innovation Center) where they are testing new products and facility designs before (they are) purchased and installed at hospitals.

“He was impressed and could take some inspiration with him on the airplane home to Denmark, where we need to build a number of new hospitals,” the article read.

Haarder added: “It is important that we do not build past (outdated) hospitals but (rather) hospitals for the future.”