Recorded presentation

Douglas Shearer, MBA¹, Nancy Parker Taylor, MBA², Tova Wolking, MPH³, Kate Eresian Chenok, MBA², and Neil Baker, MD⁴. (1) Council of Accountable Physician Practices (CAPP), One Kaiser Plaza, 27th Floor, Oakland, CA 94612, 510-271-2694, Douglas.Shearer@kp.org, (2) Council of Accountable Physician Practices, 1246 Rimer Dr., Moraga, CA 94556, (3) Institute for Health Policy, Kaiser Permanente, 1 Kaiser Plaza, 22B, Oakland, CA 94612, (4) Clinical Improvement and Education, Group Health Cooperative, 201 16th Ave E, Seattle, WA 98112

Due to the complexity and volume of knowledge and general lack of sufficient systems and processes for dissemination, it can take years for beneficial innovations reported in medical research to spread into actual practice. For instance, even though heart attacks are this nation’s leading killer, the Institute of Medicine reports that nearly half of America’s heart attack patients do not receive the most effective follow-up care. In fact, the 2003 RAND study on quality of care reported that Americans receive only about half the care they need for all common ailments.

Certain types of care delivery systems though, notably group practices with incentives to focus on prevention and an ability to care for patients with complex and chronic conditions, are well equipped to bridge the “quality chasm.” Two examples are Group Health Cooperative (GHC) in Washington and Kaiser Permanente Northern California (KPNC).

GHC took decisive action, based on Heart Protection Study results showing that the use of cholesterol lowering drugs in high-risk patients could greatly reduce their rates of heart attacks, strokes, and death. Within a month of the 2002 Lancet publication, GHC had evaluated the evidence, translated it into specific clinical recommendations, and analyzed their impact on patients, cost, and clinical quality. Within eight months, GHC implemented recommended care processes and produced significant results. Within less than a year, organization-wide, they saw the proportion of at-risk diabetics on cholesterol lowering drugs increase from 30% to 50%, with an estimated prevention of 750 heart attacks and heart surgeries, and savings of $5 million over 5 years.

In another example, KPNC’s chronic care management program uses clinical information technology, such as a computerized disease registry, electronic caregiver support tools, and automatic prompts to target several chronic conditions. This program has improved early intervention in heart disease to the point that it is no longer the number one cause of death among Kaiser Permanente’s members in Northern California—although it remains so for the California population at large.

The Council for Accountable Physician Practices (CAPP) will present case studies from GHC, KPNC and other integrated multi-specialty group practices, demonstrating how they are uniquely positioned to increase quality and improve population health, efficiently.

CAPP's mission is to foster the evolution and development of the accountable physician group model. Its members strive to promote a health care system that is more accountable to patients, consumers, and purchasers.

Learning Objectives:

• Identify key delivery system features needed to effectively address chronic care issues, such as heart disease and diabetes.
• Describe how team-based care, peer-reviewed protocols, and the use of information technology have increased efficiency and improved quality in several organizations.
• Discuss how other organizations can incorporate lessons learned from accountable physician practices.

Keywords: Accountability, Evidence Based Practice

Related Web page: www.amga.org/CAPP

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am an employee

Recorded presentation