The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #55030

Jodi S. Joyce, BSN, MBA, Kaiser Permanente Care Management Institute, One Kaiser Plaza, 16L, Oakland, CA 94612, 510-271-6404, jodi.joyce@kp.org

Kaiser Permanente’s Care Management Institute (CMI) was established in 1997 to develop, deploy, and demonstrate improved outcomes through evidence-based population management programs. CMI has gained substantial experience through its development and implementation of 8 comprehensive care management programs addressing the following Kaiser Permanente (KP) populations: Asthma - 95,000 members; Coronary Artery Disease - 145,000 members; Depression - 480,000 members; Diabetes - 420,000 members; Elder Care - 800,000 members; Heart Failure - 70,000 members; Cancer (adjunctive therapies) - establishing baseline; Chronic Pain - establishing baseline.

Our key learnings include the following:

1. Self-Care plays a central role in improved quality of life and health care utilization for individuals with chronic conditions, resulting in measurable improvements in health status and decreases in utilization.

2. Large improvements are achievable in care processes and intermediate outcomes. Among our 420,000 members with diabetes, for example, lipid testing has almost doubled in the past 5 years and lipid control has improved by a relative increase of 101%.

3. KP's "average" regional performance today exceeds that of our "leading edge" regions 5 years ago, and the gaps between "average" and "leading edge" are narrowing.

4. Improvements in end-outcomes take more time, but KP's incidence rates for such events as AMIs, stroke, and other CV events have dropped measurably.

5. Population management is yielding cost reductions in some populations (e.g. diabetes) and improved survival in other (e.g. CAD).

6. Co-morbidities are a challenge, requiring better solutions than exist today. This dilemma will be magnified as our population continues to age (from 13% 65+ today to 20% in 2030) and gain weight (from 47% overweight or obese in 1976 to 70% today), since advancing age and weight each bring higher chronic condition prevalence and higher health care costs.

7. Barriers exist to clinicians relying on evidence. Having a deep understanding of the challenges enables the creation of effective strategies for addressing and overcoming these barriers.

The most promising solutions include: Harnessing the central role of the health care consumer; Basing programs on best evidence; Managing the whole population; Anticipating and accommodating co-morbidities; Acknowledging the complexities and challenges of clinical practice; Building and using a robust capacity and capability for measurement of the entire population and for value demonstration; Leveraging common integrated systems involving the consumer, clinician, and elements of the delivery system.

Ample KP data will be shared re: each of the 7 key learnings.

Learning Objectives:

At the conclusion of this presentation, the participant will understand:
• The central role of self-care in effective population management;
• Where population management has the biggest impact, and what outcomes are harder to influence;
• How prevalence and severity of chronic illness are changing;
• The challenges clinicians face in utilizing evidence in practice

Keywords: Chronic Diseases, Evidence Based Practice

Related Web page: www.kpcmi.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Kaiser Permanente Care Management Institute
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.